Solam Lee, Young Bin Lee, Sung Jay Choe, Won-Soo Lee
DOI: 10.2340/00015555-3035

Treatment of male androgenetic alopecia with 5α-reductase inhibitors is efficacious. However, the risk of adverse sexual effects remains controversial. This systematic review and meta-analysis investigated the risk of adverse sexual effects due to treatment of androgenetic alopecia in male patients with finasteride, 1 mg/day, or dutasteride, 0.5 mg/day. Fifteen randomized double-blinded placebo-controlled trials (4,495 subjects) were meta-analysed. Use of 5α-reductase inhibitors carried a 1.57-fold risk of sexual dysfunction (95% confidence interval (95% CI) 1.19–2.08). The relative risk was 1.66 (95% CI 1.20–2.30) for finasteride and 1.37 (95% CI 0.81–2.32) for dutasteride. Both drugs were associated with an increased risk, although the increase was not statistically significant for dutasteride. As studies into dutasteride were limited, further trials are required. It is important that physicians are aware of, and assess, the possibility of sexual dysfunction in patients treated with 5α-reductase inhibitors.

Oral 5α-reductase inhibitors, including finasteride and dutasteride, are the preferred and most efficacious treat­ment modalities for male androgenetic alopecia (male pattern baldness). Despite their promising efficacy on hair regrowth, there is debate about their adverse effect of these drugs on sexual function. In this systematic review and meta-analysis of randomized double-blinded placebo-controlled trials, the use of oral 5α-reductase inhibitors had an overall 1.55-fold risk of sexual dysfunction, including erectile dysfunction, decreased libido and ejaculatory dysfunction. Therefore, potential sexual adverse events should be assessed in patients treated with oral finasteride or dutasteride.

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