The effect of 5α-reductase inhibition with dutasteride and finasteride on bone mineral density, serum lipoproteins, hemoglobin, prostate specific antigen and sexual function in healthy young men
The effect of 5α-reductase inhibition with dutasteride and finasteride on bone mineral density, serum lipoproteins, hemoglobin, prostate specific antigen and sexual function in healthy young men
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DOI：
10.1016/j.juro.2008.01.145
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发表时间：
2008-06-01
影响因子：
6.6
通讯作者：
Clark, Richard V.
中科院分区：
文献类型：
--
作者：
Amory, John K.;Anawalt, Bradley D.;Clark, Richard V.
目的：度他雄胺和非那雄胺是5 α-还原酶抑制剂，可显著降低血清双氢睾酮水平。由于雄激素影响骨、脂质、造血、前列腺和性功能，我们确定了5 α-还原酶抑制剂对这些终点的影响。材料和方法：我们进行了一项随机、双盲、安慰剂对照试验，99名18至55岁的男性随机分配接受0.5 mg度他雄胺（33），每天5 mg非那肽（34）或安慰剂（32），持续1年。在基线、治疗1年后和停药6个月后测量骨密度。此外，在基线、治疗26周和52周后以及停药24周后再次测量骨转换标志物、空腹血清脂蛋白浓度、血红蛋白和前列腺特异性抗原。性功能在这些点进行了评估，通过一个有效的questionnaire.Results：显着抑制循环双氢睾酮水平与管理度他雄胺或芬那雄胺没有显着影响骨密度或骨代谢标志物。同样，血清脂蛋白和血红蛋白不受影响。血清前列腺特异性抗原和自我评估的性功能在5 α-还原酶抑制剂治疗期间略有下降，但在随访期间恢复到基线水平。在1年期间由5 α-还原酶抑制剂诱导的循环血清二氢睾酮的深度抑制不会对骨、血清脂蛋白或血红蛋白产生不利影响，对正常男性血清前列腺特异性抗原和性功能的可逆性影响。在正常男性中，循环双氢睾酮似乎在调节骨量、造血或脂质代谢方面没有临床意义。
Purpose: Dutasteride and finasteride are 5 alpha-reductase inhibitors that dramatically decrease serum levels of dihydrotestosterone. Because androgens affect bone, lipids, hematopoiesis, prostate and sexual function, we determined the impact of 5 alpha-reductase inhibitors on these end points.Materials and Methods: We conducted a randomized, double-blinded, placebo controlled trial of 99 men 18 to 55 years old randomly assigned to receive 0.5 mg dutasteride (33), 5 mg finasteride (34) or placebo (32) daily for 1 year. Bone mineral density was measured at baseline, after 1 year of treatment and 6 months after drug discontinuation. In addition, markers of bone turnover, fasting serum lipoprotein concentrations, hemoglobin and prostate specific antigen were measured at baseline, after 26 and 52 weeks of treatment, and again 24 weeks after drug discontinuation. Sexual function was assessed at these points by a validated questionnaire.Results: Significant suppression of circulating dihydrotestosterone levels with the administration of dutasteride or finasteride did not significantly affect bone mineral density or markers of bone metabolism. Similarly serum lipoproteins and hemoglobin were unaffected. Serum prostate specific antigen and self-assessed sexual function decreased slightly during treatment with both 5 alpha-reductase inhibitors but returned to baseline during followup.Conclusions: Profound suppression of circulating serum dihydrotestosterone induced by 5 alpha-reductase inhibitors during 1 year does not adversely impact bone, serum lipoproteins or hemoglobin, and has a minimal, reversible effect on serum prostate specific antigen and sexual function in normal men. Circulating dihydrotestosterone does not appear to have a clinically significant role in modulating bone mass, hematopoiesis or lipid metabolism in normal men.