[I]t is utmost important to identify individuals with a previous history of depression, sexual dysfunction or infertility who may be more susceptible for the various side effects. The risks should than be discussed with the patient and weighed out against the benefits of the use of 5ARIs as mentioned in the introduction. Men under the age of 40 who use finasteride for alopecia are at risk for suicide if they develop persistent sexual adverse effects and insomnia. Physicians need more awareness regarding the decrease of PSA due to 5ARIs of 50% after 6 to 12 months use which can mask high-grade prostate cancer. They should restrict the 5ARIs to patients with a prostate volume of >40 ml according the EAU guideline 2023. Therapeutic innovation is urgently needed that might cure or relieve this wide range of health risks.
Leliefeld, H.H.J., Debruyne, F.M.J. & Reisman, Y: IJIR, 2023, Sept. 11 https://doi.org/10.1038/s41443-023-00759-5. [International Journal of Impotence Research]