The Prevalence of 5 Alpha Reductase Inhibitor Adverse Events in Patients with Benign Prostatic Hyperplasia in Jamaica

Aim: To determine the prevalence of adverse effects (sexual dysfunction, depression and gynaecomastia) of 5-ARIs in patients with BPH in Jamaica.

Study Design: A Prospective Cohort Study.

Place and Duration of Study: Genitourinary Outpatient Departments at the University Hospital of the West Indies and Kingston Public Hospital in Kingston, Jamaica between September 2021 and September 2022.

Methodology: We included 80 patients with inclusion criteria: all patients with symptomatic BPH being commenced on 5-ARIs with no prior history of conditions considered as adverse effects. Patients were administered a two-time descriptive questionnaire designed to assess the recognized adverse effects of 5-ARIs. The change from baseline to interval follow-up on the Male Sexual Health Questionnaire (MSHQ) erection, ejaculation, sexual desire scores and Hospital Anxiety and Depression Scale Depression subscale (HADS-D) score and the development of gynaecomastia (primary outcomes) and personal stressors experienced (secondary outcome) were assessed, using a standard software package.

Results: Ten percent of patients self-reported adverse effects. There was a statistically significant reduction (worsening) in the MSHQ erection score from baseline (34.08; sd 8.99) to 33.26 (sd 9.42; p=0.05) after commencing 5-ARI but no significant change in ejaculation (difference of 0.43; p= 0.15) and sexual desire (difference of 0.01; p=0.98) scores. No signs of depression were noted in patients taking 5-ARI up to 6 months with the mean HADS-D score at baseline being 2.66 with no significant change at follow-up (2.50; p = 0.24). The development of gynaecomastia was not significant (p= 0.630). The proportion of patients who experienced personal stressors was lower after commencing 5-ARIs compared with baseline (8 patients; 10% vs 33 patients; 41.25%).

Conclusion: 5-ARIs are associated with a reduction in MSHQ erection score within 6 months of therapy and may correlate to the onset of erectile dysfunction. Depression and gynaecomastia are not recognized short term adverse effects of 5-ARIs.