Effect of a Combination of Dutasteride and Parenteral Testosterone Undecanoate on Testosterone Deficiency Symptoms and Prostate in Patients with Testosterone Efficiency and Benign Prostatic Hyperplasia

Main Article Content

Sun Gu Park
Seok Cho
Jae Yoon Kim
Jeong Kyun Yeo
Min Gu Park


benign prostatic hyperplasia, dihydrotestosterone, dutasteride, estosterone deficiency, testosterone undecanoate


Background and objective

The effect of a combination of testosterone and 5-Alpha reductase inhibitors (5-ARIs) on serum testosterone levels, TD symptoms, and the prostate are not sufficiently established. Therefore, we examined the effects of long acting parenteral testosterone undecanoate (TU) and dutasteride used in combination for the treatment of BPH patients with TD.
Subjects and methods

We selected 130 patients with a prostate volume (PV) > 30 g from those diagnosed with TD and had received parenteral TU for 1 year. These patients were assigned to the following two groups: Group I, which comprised patients who received TU injections along with dutasteride, and Group II, which included patients with TU-only treatment. Statistical analyses were performed between the two groups to compare the results of serological tests, symptom questionnaire scores, and PV.

No significant differences were observed in the baseline characteristics such as mean age, comorbidities, testosterone levels, symptom questionnaire scores between the two groups. There were no significant differences in the testosterone levels or the change in testosterone levels after treatment between the two groups. The PV was significantly increased in Group II and significantly decreased in Group I. Both groups showed a significant increase in the total scores and all subscale scores of the IIEF and AMS after treatment. Group II had a significantly higher total IIEF score than Group I and a significantly lower score in the sexual function subscale of the AMS after treatment.

The combination of TU and dutasteride considerably improved serum testosterone levels, alleviated TD symptoms, and effectively reduced PV in patients with TD and BPH. However, compared with the TU-only treatment, the combination was less effective in improving symptoms related to sexual function. Therefore, dutasteride should be used with caution when treating BPH patients with TD, who mainly complain of sexual dysfunction.


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1. Moon DG, Park MG, Lee SW, et al. The efficacy  and safety of testosterone undecanoate (Nebido(R)) in testosterone deficiency syndrome in Korean: A multicenter prospective study. J Sex Med 2010;7:2253–60. https://doi.org/10.1111/j. 1743-6109.2010.01765.x
2. Gormley GJ, Stoner E, Bruskewitz RC, et al. The effect of finasteride in men with benign prostatic hyperplasia. N Engl J Med 1992;327:1185–91. https://doi.org/10.1056/NEJM199210223271701
3. Roehrborn CG, Boyle P, Nickel JC, Hoefner K, Andriole G. Efficacy and safety of a dual inhibi-tor of 5-alpha-reductase types 1 and 2 (dutasteride) in men with benign prostatic hyperplasia. Urology 2002;60:434–41. https://doi.org/10.1016/ S0090-4295(02)01905-2
4. Traish AM. Health Risks associated with long-term finasteride and dutasteride use: It’s time to  sound the alarm. World J Mens Health 2020;38:e17. https://doi.org/10.5534/wjmh.200012
5. Liu L, Zhao S, Li F, et al. Effect of 5alpha-reduc-tase inhibitors on sexual function: A meta-analy-sis and systematic review of randomized controlled trials. J Sex Med 2016;13:1297–310. https://doi.org/10.1016/j.jsxm.2016.07.006
6. Kaplan SA, Chung DE, Lee RK, Scofield S, Te AE. A 5-year retrospective analysis of 5alpha-re-ductase inhibitors in men with benign prostatic hyperplasia: Finasteride has comparable urinary symptom efficacy and prostate volume reduction, but less sexual side effects and breast complica-tions than dutasteride. Int J Clin Pract 2012;66:1052–5. https://doi.org/10.1111/j.1742-1241.2012.03010.x
7. Minnemann T, Schubert M, Hubler D, et al. A four-year efficacy and safety study of the long-acting par-enteral testosterone undecanoate. Aging Male 2007;10:155–8. https://doi.org/10.1080/1368553070 1437510
8. Pechersky AV, Mazurov VI, Semiglazov VF, Karpischenko AI, Mikhailichenko VV, Udintsev AV. Androgen administration in mid-dle-aged and ageing men: Effects of oral tes-tosterone undecanoate on dihydrotestosterone, oestradiol and prostate volume. Int J Androl 2002;25:119–25. https://doi.org/10.1046/j.1365-2605.2002.00335.x
9. Traish AM, Johansen V. Impact of testosterone deficiency and testosterone therapy on lower uri-nary tract symptoms in men with metabolic syn-drome. World J Mens Health 2018;36:199–222. https://doi.org/10.5534/wjmh.180032
10. Roehrborn CG, Lee M, Meehan A, Waldstreicher J. Effects of finasteride on serum testosterone and body mass index in men with benign prostatic hyperplasia. Urology 2003;62:894–9. https://doi. org/10.1016/S0090-4295(03)00661-7
11. Hong SK, Min GE, Ha SB, et al. Effect of the dual 5alpha-reductase inhibitor, dutasteride, on serum testosterone and body mass index in men with benign prostatic hyperplasia. BJU Int 2010;105:970–4. https://doi.org/10.1111/ j.1464-410X.2009.08915.x
12. Gur S, Kadowitz PJ, Hellstrom WJ. Effects of 5-alpha reductase inhibitors on erectile function, sexual desire and ejaculation. Expert Opin Drug Safety 2013;12:81–90. https://doi.org/10.1517/147 40338.2013.742885
13. Wang C, Nieschlag E, Swerdloff R, et al. Investigation, treatment, and monitoring of late-onset hypogonadism in males: ISA, ISSAM, EAU, EAA, and ASA recommendations. Eur Urol 2009;55:121–30. https://doi.org/10.1016/j. eururo.2008.08.033
14. Morgentaler A, Traish AM. Shifting the paradigm of testosterone and prostate cancer: The saturation model and the limits of androgen-dependent growth. Eur Urol 2009;55:310–20. https://doi. org/10.1016/j.eururo.2008.09.024
15. Hackett G, Kirby M, Edwards D, et al. British Society for Sexual Medicine Guidelines on Adult Testosterone Deficiency, with statements for UK practice. J Sex Med 2017;14:1504–23. https://doi. org/10.1016/j.jsxm.2017.10.067
16. Mirone V, Debruyne F, Dohle G, et al. European Association of Urology Position Statement on the role of the urologist in the management of male hypogonadism and testosterone therapy. Eur Urol 2017;72:164–7. https://doi.org/10.1016/j.eururo. 2017.02.022
17. Mulhall JP, Trost LW, Brannigan RE, et al. Evaluation and management of testosterone deficiency: AUA guideline. J Urol 2018;200:423– 32. https://doi.org/10.1016/j.juro.2018.03.115
18. Shin YS, Karna KK, Choi BR, Park JK. Finasteride and erectile dysfunction in patients with benign prostatic hyperplasia or male androge-netic alopecia. World J Mens Health 2019;37: 157–65. https://doi.org/10.5534/wjmh.180029
19. Schirar A, Bonnefond C, Meusnier C, Devinoy E. Androgens modulate nitric oxide synthase mes-senger ribonucleic acid expression in neurons of the major pelvic ganglion in the rat. Endocrinology 1997;138:3093–102. https://doi.org/10.1210/endo. 138.8.5310
20. Kiyokage E, Toida K, Suzuki-Yamamoto T, Ishimura K. Localization of 5alpha-reductase in the rat main olfactory bulb. J Comp Neurol 2005;493:381–95. https://doi.org/10.1002/cne.20760
21. Lephart ED. Age-related changes in brain and pituitary 5 alpha-reductase with finasteride (Proscar) treatment. Neurobiol Aging 1995; 16:647–50. https://doi.org/10.1016/0197-4580 (95)98115-5
22. Page ST, Amory JK, Bowman FD, et al. Exogenous testosterone (T) alone or with finasteride increases physical performance, grip strength, and lean body mass in older men with low serum T. J Clin Endocrinol Metab 2005;90:1502–10. https://doi. org/10.1210/jc.2004-1933
23. Bhasin S, Travison TG, Storer TW, et al. Effect of testosterone supplementation with and without a dual 5alpha-reductase inhibitor on fat-free mass in men with suppressed testosterone production: A randomized controlled trial. JAMA 2012;307:931–9. https://doi.org/10.1001/jama.2012.227
24. Page ST, Hirano L, Gilchriest J, et al. Dutasteride reduces prostate size and prostate specific antigen in older hypogonadal men with benign prostatic hyperplasia undergoing testosterone replacement therapy. J Urol 2011;186:191–7. https://doi. org/10.1016/j.juro.2011.03.026