Health Risks Associated with Long-Term Finasteride and Dutasteride Use: It's Time to Sound the Alarm
Abstract
5?-dihydrotestosterone (5?-DHT) is the most potent natural androgen. 5?-DHT elicits a multitude of physiological actions, in a host of tissues, including prostate, seminal vesicles, hair follicles, skin, kidney, and lacrimal and meibomian glands. However, the physiological role of 5?-DHT in human physiology, remains questionable and, at best, poorly appreciated. Recent emerging literature supports a role for 5?-DHT in the physiological function of liver, pancreatic ?-cell function and survival, ocular function and prevention of dry eye disease and kidney physiological function. Thus, inhibition of 5?-reductases with finasteride or dutasteride to reduce 5?-DHT biosynthesis in the course of treatment of benign prostatic hyperplasia (BPH) or male pattern hair loss, known as androgenetic alopecia (AGA) my induces a novel form of tissue specific androgen deficiency and contributes to a host of pathophysiological conditions, that are yet to be fully recognized. Here, we advance the concept that blockade of 5?-reductases by finasteride or dutasteride in a mechanism-based, irreversible, inhabitation of 5?-DHT biosynthesis results in a novel state of androgen deficiency, independent of circulating testosterone levels. Finasteride and dutasteride are frequently prescribed for long-term treatment of lower urinary tract symptoms in men with BPH and in men with AGA.
This treatment may result in development of non-alcoholic fatty liver diseases (NAFLD), insulin resistance (IR), type 2 diabetes (T2DM), dry eye disease, potential kidney dysfunction, among other metabolic dysfunctions. We suggest that long-term use of finasteride and dutasteride may be associated with health risks including NAFLD, IR, T2DM, dry eye disease and potential kidney disease.
https://pubmed.ncbi.nlm.nih.gov/32202088/