Health Risks Associated With Long-Term Finasteride and Dutasteride Use: It's Time to Sound the Alarm

[pjoshea13]

New paper below, [1].

Nalakrats & I believe there is a role for a 5-alpha reductase inhibitor in advanced PCa. Some disagree. I would be remiss if I didn't point out that long-term use (as with all PCa drugs) has a downside:

"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."

When my prostatectomy failed 16 years ago, I wasn't concerned that salvage radiation increased the risk of other cancers. Those risks were not apparent for 5 years. I was starting to think short term.

For those taking the long view, this paper may be of interest.

Incidentally, Avodart has a long half-life. Taking a vacation from the drug isn't so easy.

-Patrick

[1] pubmed.ncbi.nlm.nih.gov/322...

Review World J Mens Health

2020 Mar 20[Online ahead of print]

Health Risks Associated With Long-Term Finasteride and Dutasteride Use: It's Time to Sound the Alarm

Abdulmaged M Traish 1

Affiliations collapse

Affiliation

1 Department of Urology, Boston University School of Medicine, Boston, MA, USA. [e-mail].

PMID: 32202088 DOI: 10.5534/wjmh.200012

Abstract

5α-dihydrotestosterone (5α-DHT) is the most potent natural androgen. 5α-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 5α-DHT in human physiology, remains questionable and, at best, poorly appreciated. Recent emerging literature supports a role for 5α-DHT in the physiological function of liver, pancreatic b-cell function and survival, ocular function and prevention of dry eye disease and kidney physiological function. Thus, inhibition of 5α-reductases with finasteride or dutasteride to reduce 5α-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 5α-reductases by finasteride or dutasteride in a mechanism-based, irreversible, inhabitation of 5α-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.

Keywords: 5-alpha reductase inhibitors; Diabetes mellitus; Dry eye syndromes; Hypogonadism; Kidney diseases; Non-alcoholic fatty liver disease.

Copyright © 2020 Korean Society for Sexual Medicine and Andrology.

[cesanon]

"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."

Wow, I was using it for a long time before Sartor took me off of it.

I was totally unaware of these side effects.

[Garp41]

selfhacked.com/blog/hidden-...

Lot of ways to naturally decrease DHT.

Doug

[jdm3]

Thanks. Just when I think I'm doing the right thing by taking Avodart to lower DHT, I read that there may be some serious long-term consequences. I suppose we have to weigh the risks... but it's never a simple answer. Ugh.

[timotur]

One noteworthy key word (in bold):

"Here, we advance the concept that blockade of 5α-reductases by finasteride or dutasteride in a mechanism-based, irreversible, inhabitation of 5α-DHT biosynthesis results in a novel state of androgen deficiency, independent of circulating testosterone levels."

[noahware]

Well, long-term ADT itself shows risks of potential metabolic dysfunctions, so this is not really surprising. But it is enlightening!

[PhilipSZacarias]

Concomitant use of dutasteride when taking abiraterone appears to inhibit some of the metabolites of abiraterone that are agonists. Cheers, Phil

[Shanti1]

Seems like many of these long-term side-effects can be offset by a healthy diet and exercise and there is a lot of cross over with general ADT side effects. Those who chose to go for the benefit of 5a-reductase inhibitors should be mindful to increase their benefit/risk ratio by choosing a lifestyle that is associated with health metabolism and by checking glucose, insulin, kidney markers, and lipids regularly.

[pjoshea13 in reply to Shanti1]

Good advice! -Patrick

[Drphil1938]

So when you say long term. What do you mean, I have been on finesteride for 18 mos. Is that to long?

[pjoshea13 in reply to Drphil1938]

Maybe there is a point at which one should take a long break. I think of 5+ years as very long term in our demographic. I have been on it much longer than that but I will continue for now. I'm not aware of any issues. I tend to blame everything on the absence of testosterone..

-Patrick

[spud544 in reply to Drphil1938]

Anecdotal, of course, but on finasteride for five years with no bad side effects.

[Hidden]

How long have you been using the Avodart, Nal? I was going to pitch it to my oncologist as an add-on to a proposed Eligard-Apalutamide combo (in the works in a couple of weeks). ADT3 and then some chemo might slow the cancer down a wee bit.

[dmt1121]

I was taking it for years before my Dx. Just one more set of fun facts to add to the pile.......

[Justt]

Me too..I had been a Finasteride user for around 8 years, daily. As I noticed my libido slowly vanishing, I decided to radically stop it..Soon after, I noticed my sperm volume decrease really a lot to less than half, but Dr. Urologist stated would be fully normal for men in the early 50s..But then, around 2 years later, came a psa of 9.3 and Pca diagnosis...

[pjoshea13 in reply to Justt]

Did you ever have testosterone [T] tested?

A potential benefit of Finasteride / Dutasteride is higher T, i.e. by the amount not converted to dihydrotestosterone [DHT].

However, if your estradiol [E2] : T ratio is high, you might not see much benefit at all, due to increased SHBG levels. Studies are mixed.

The changes you noted seems to suggest that your T was higher.

-Patrick

[Justt in reply to pjoshea13]

Back then, never tested T..

[tsim in reply to Justt]

If I might ask, were you taking the Finasteride for a chronic prostatitis condition?

[Justt in reply to tsim]

No, actually just hair loss..

[pjoshea13 in reply to Justt]

So you were using Propecia (1 mg) rather than Proscar (5 mg).

-Patrick

[Justt in reply to pjoshea13]

1mg, only..But one never knows.. If a friend would ask me today about hormonal medications just for hair loss issues..I'd surely answer with a loud , No...keepdistance!!

[tsim in reply to Justt]

It's better to go to Bosley, no side effects except more honeys hanging around

[Sisira]

Patrick,

I have been using Avodart ( one capsule every 3 days ) since 2016 even after stopping all my other treatments. I was diagnosed in 2015 for GS9 PCa. Treated with RP + IMRT + ADT ( 2 Yrs ) and my PSA after treatment remaining at 0.008ng/ml throughout up to now. Some says in my situation continuing with Avodart is of no use. My preference to continue was only the"Dr.Myers" factor. Since of late I have developed NAFLD and dry eyes for no conceivable reasons. I think I have to give serious thoughts to the facts disclosed in your text and stop taking Avodart.

Patrick, will it not be a wiser decision?

Thank you for giving us the updated information as you usually do.

Sisira

[pjoshea13 in reply to Sisira]

Well, NAFLD, which is a silent epidemic in the U.S., is not to be messed with IMO. & any eye condition that can be avoided. I would take a break from Avodart. It would have to be a long break, considering the lengthy half-life.

Best, -Patrick

[Sisira in reply to pjoshea13]

Patrick,

I respect your view point and chose to discontinue with Avodart.

Thanks

Sisira

[Hidden]

I wonder what the "may" really means. Even a SWAG about precentage risk compared to normal incidence would be helpful.