Comorbidities play a role in the sexual dysfunction linked to use of 5-alpha-reductase inhibitors prescribed for androgenetic alopecia (AGA). That’s according to research presented at a medical residents and fellows symposium at the annual meeting of the American Academy of Dermatology and published in the October/November issue of The Chronicle of Skin & Allergy.
“Obesity, diabetes, nicotine dependence, high blood pressure, anxiety disorders, and mood disorders may play a significant role in the sexual dysfunction that we see in patients undergoing 5-alpha reductase inhibitor therapy,” said Dr. Kyle Lauck, a second-year dermatology resident at Baylor University Medical Center in Dallas. “We noted that the relationship between drug exposure and sexual dysfunction is not significant without the presence of comorbidities.”
While there has been an association between sexual dysfunction and use of 5-alpha reductase inhibitors such as finasteride and dutasteride, as cited in the medical literature and consumer media, Dr. Lauck noted there is a lack of consensus about their impact on sexual function.
Using the TriNetX Analytics network platform, a comprehensive tool to pull data from thousands of records of patients with AGA, Dr. Lauck and co-investigators evaluated the risk of sexual dysfunction up to one year following a diagnosis of AGA.
The network permitted access to records of 10,585 AGA patients who were exposed to 5-alpha reductase inhibitor treatment within 30 days after receiving a diagnosis of AGA, and access to records of 12,752 control subjects, defined as having AGA but with no history of any prescription for a 5-alpha reductase inhibitor.
“In analyzing 20,000 patients, this represents the largest single analysis of sexual dysfunction and androgenetic alopecia patients to date,” said Dr. Lauck.
Given how common comorbidities can be in men aged 50 years and older, investigators conducted further analysis, looking at patients who were positive for sexual dysfunction and taking into account the presence of comorbidities including obesity, diabetes mellitus, history of nicotine dependence, essential hypertension, mood disorders, and anxiety disorders. Of note, hypertension, mood disorders, and anxiety disorders were fairly common in these patients with 18%, 22%, and 30% being positive for hypertension, mood disorders, and anxiety disorders, respectively.
“The relationship between drug exposure and sexual dysfunction became less and less [statistically] significant until after excluding patients with any of these comorbidities, we found the relationship between drug exposure and sexual dysfunction was no longer [statistically] significant,” said Dr. Lauck in an interview with The Chronicle of Skin & Allergy.
After eliminating comorbidities, the risk of sexual dysfunction in patients who took 5-alpha reductase inhibitors was not significant (p=0.061).
One of the take-home messages for clinicians is to recognize that comorbidities will influence the risk of sexual dysfunction, according to Dr. Lauck.
“Sexual dysfunction as a whole is multifaceted,” he said in an interview. “It has psychological elements, and it has physical elements. And there are things beyond simply exposure to the drug [5-alpha reductase inhibitor], which can play a significant role in sexual dysfunction occurring.”
—with files from Chronicle Correspondent Louise Gagnon
Comments