The most effective medications for the treatment of prostate adenoma in men. The most effective medications for the treatment of prostate adenoma in men Herbs 5 alpha reductase inhibitors tablets

Are you here: Sense organs

Big upgrade to the hair theme (skin and nails too)

There is something new and good.
We will talk about several effective remedies for hair loss, and they are also for restoring the thickness and density of hair.

First, in order not to waste money, you need to be examined and find out the cause of hair loss, the most common of which is low reserves in the body and dysfunction.

Pills, mask, shampoo, conditioner and serum. At the end of the article, a complex for hair (as well as skin and nails) without such serious problems (biotin and company in one).

Frankly speaking, I have known about such drugs for a long time, but I thought that someday I would get to the bottom of this hormonal ins and outs, find out the whole truth about these dihydro- and reductases, side effects in the sexual sphere, and then we would boldly block what is not blocked. Well, the moment has come.

Zenwise Health, Hair Growth, Vitamins Plus Dihydrotestosterone (DHT) Blocker, 120 Veggie Caps. Jar for 2 months. More precisely, it is not a blocker, but a set of substances that work as dihydrotestosterone blockers.

DHT Blocker does not contain hormones and synthesized DHT blockers (DHT), the composition is completely natural. Below I will list some components that can also be taken in courses, for example, in between courses of the Zenwise Health complex.

What is dihydrotestosterone and why block it.

Let's go from afar, a little science:

The growth cycle of scalp hair is on average 5-7 years and consists of three phases.
1. During the anagen phase, which occupies almost the entire time of the cycle, active hair growth occurs; up to 85% of hair is in this phase.
2. Catagen - lasts 3-4 weeks; during this period, the hair follicle detaches from the neurovascular bundle and sheds its membrane; 1% of hair remains in this phase.
3. The telogen, or resting phase, lasts 3-4 months, during which time the essentially dead hair is pushed out by the growing new one, and it falls out. 14% of hair is in this phase.
The hair growth rate is approximately 0.35 mm per day or 1 cm per month.
Losing up to 100 hairs per day is normal.

If you are losing more than 100 hairs per day, this indicates that the healthy balance between the phases has been disrupted, the amount of anagen and catagen hair is decreasing and the percentage of telogen hair is increasing.

Testosterone, a sex hormone found in both men and women, combines with 5-alpha reductase, an enzyme involved in steroid metabolism. This results in the production of DHT (dihydrotestosterone), a compound that can cause damage to hair follicles. At the same time, the content of sex hormones in the blood usually does not exceed normal levels.
Thus, all the hair problems associated with dihydrotestosterone occur not because of its overwhelming amount, but because of the sensitivity of the hair follicles to DHT, this is often associated with genes and is inherited. This sensitivity is the goal of dihydrotestosterone blockers.

A few more details about the interaction of DHT with follicles.
In women, inside the hair follicle, the hormone testosterone (which is produced by the adrenal cortex) is converted into 5-alpha-dihydrotestosterone under the influence of 5-alpha reductase. This substance causes a very long-term spasm of the vessels that feed the follicle, as a result of which a complex biochemical process is launched, at the end of which protein synthesis is disrupted.
Follicle degeneration occurs, the result of which is a shortening of the growth phase (this is the one that is anagen).
Over the course of approximately 1 year, dystrophy is moderately expressed, manifested by a decrease in the size of hair follicles, thinning of hair, transformation of coarse hair into vellus hair, and sometimes discoloration.
Over the course of 2-3 cycles, dystrophy progresses to the point of blocking the anagen phase, that is, the follicle stops “producing” hair, and a scar develops in place of the dead follicle.

For women, hair loss usually coincides with hormonal changes - for example, during menopause, after childbirth, as a result of starting or stopping oral contraceptives, during stress, etc.

What you can do (for men and women):

- correct excess DHT
— protect the hair follicle from the action of DHT;
- stimulate hair growth, create the best conditions for it
— eliminate mineral and vitamin deficiency and imbalance

There are cases of erectile dysfunction and decreased libido resulting from the use of finasteride and other pharmaceutical DHT blocking drugs that persist even after stopping use of the drug.
Natural remedies are not as powerful, but do not have these side effects. But in any case, the strategy of blocking dihydrotestosterone using natural remedies works well for women and may have minor side effects for men.

It is clear that we cannot block testosterone in either men or women. Fortunately, there are two other components of the process, and both can be inhibited: 5-alpha reductase and DHT.
Below you will find a list of dihydrotestosterone blockers (most of which are included in the Zenwise Health complex). That's what they're called, but to be more precise, some of them block DHT itself, while others inhibit the activity of 5-alpha reductase, thereby preventing the production of DHT.

– Fish oil () – curbs excess production of DHT. This is a basic substance, for every day, so I’m not writing about any courses of use. From the Omega-3 list, I highly recommend Carlson Labs, Cod Liver Oil, because... It is full of accessible vitamin A, which is so necessary in restoring hair growth.

— Evening primrose oil (as a source of gamma-linolenic acid) – inhibits 5-alpha reductase.

— Saw palmetto extract (saw palmetto). Inhibits the enzyme 5-alpha reductase, blocks specific receptors for DHT. The course is a month.

– Nettle (leaf only, not root)
Monthly course. Blocks the action of 5-alpha reductase.
And here in the form of a tincture - it is especially convenient because you can not only drink it, but also add it to water to rinse your scalp and hair, or to homemade masks.
An effective extract, but its substances react with everything, so spread it throughout the day with other extracts and medications.

- Zinc. Since hair growth is dependent on normal cellular reproduction and protein synthesis, zinc deficiency itself can lead to hair deterioration and loss, as well as acne. Course every two months, if necessary. Take on an empty stomach (unless otherwise stated in the annotation), separately from coffee and other metal preparations.

— Pumpkin seed oil (course 3 months after 3) — blocks the action of 5-alpha reductase, an alternative to zinc (contains it in the right amount)
Or pumpkin seeds themselves as a habit forever

- Green tea extract - helps maintain healthy DHT levels. (Many people have noticed that drinking green tea makes the skin clearer and smoother - this is the same effect). Course 3 months after 3.

— Eklonia Kava extract is a strong 5-alpha reductase inhibitor and antioxidant. One of the types of brown algae (for those who do not recommend algae, it is better to exclude it)

— B vitamins
B-complexes play an important role in healthy hair growth because they are essential for the development of the dermal layers and their appendages. For example, biotin, niacin, and cobalamin are some of the most popular B vitamins that help restore shine and thickness to hair, but all B vitamins are important for hair growth.
Together, zinc and B vitamins can inhibit the production of dihydrotestosterone (DHT), which is one of the main known causes of alopecia.

- Vitamin D3 - included in all multivitamins (you need to get 1000-2000 IU per day).
This hormone-like substance is responsible for producing the body's own antioxidants and makes DHT less toxic to the skin and hair follicles.

— Complexes for cleansing the liver. They are not related to the synthesis of DHT, but they help reduce sebum, and DHT accumulates in it.

There is no need to drink all herbal extracts at once, because... in some preparations they are in full therapeutic dosage.
For example, if you are a man and have already taken the Zenwise Health complex with DHT blockers, then take B-complex, green tea, saw palmetto and zinc (D3 and Omega-3 of course - for constant use). At other times, you can take a course of nettle and pumpkin oil. Do not get carried away with plant extracts, take breaks between all courses.

For women, primrose oil, green tea, the same vitamins and basic ones are good. Also alternate. Even though saw palmetto is considered a "male" plant, the extract is also effective for women unless you have low testosterone levels.

Attention, these vitamins and their components have a very significant bonus - they can help with hormonal acne, which very often has the same cause. DHT increases sebum production, accumulates in it, and clogs the pores with a known result.
In women, more often than in men, the cause of acne is dihydrotestosterone, because. Women's skin is more sensitive to the effects of androgens.
This, of course, is not the only factor in the formation of acne. The second term is increased insulin levels. But that's a different story.
No DHT blockers should be used before the age of 18 without the approval of a physician.

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It does not make sense to treat the condition only at the end point and block the DHT present in the scalp locally. But external agents work great together with “internal” blockers.

Now local DHT blockers acting externally. Mask, shampoo, conditioner and serum

Mask

Pura D'or, Hair Loss Prevention Therapy

Most older men, and recently often men of reproductive age, suffer from pathologies in the functioning of the prostate gland. Symptoms of the pathology may include frequent and painful urination, decreased erectile function, decreased libido, etc.

As a rule, these are consequences of prostatitis, an infectious and inflammatory process of the prostate gland, as well as complicated forms of pathology, which led to the formation of an adenoma. Complications can be avoided if correct complex therapy based on modern medical advances is carried out in a timely manner.

A properly conducted thorough examination helps to find out the cause of the pathology. Among them are usually found:

Prostatitis;

Benign prostatic hyperplasia;

Prostate cancer.

According to recent studies and statistics, benign prostatic hyperplasia (adenoma) remains the main cause of the above symptoms. Adenoma is a consequence of a long-term infectious and inflammatory process in the prostate. Since the disease is often asymptomatic, an advanced form of prostatitis leads to the formation of prostate adenoma. The question of necessity arises. It is well known that benign prostatic hyperplasia significantly reduces the quality of life and often takes a complicated course. The progressive course of the disease is expressed in worsening symptoms, acute, unbearable pain, which significantly reduces the quality and life expectancy.

As a type of surgical intervention, it is the standard treatment for benign prostatic hyperplasia. However, drug therapy for disorders caused by this pathology also finds its use. New drugs are being developed to help provide effective drug therapy. Patients with primary manifestations of urinary disorders, without severe complications of the upper urinary tract, patients with contraindications to surgery, who refused surgery on their own or in consultation with a doctor, choose appropriate drug therapy.

In such cases, drugs based on 5-alpha reductase inhibitors are usually used.

5-alpha reductase in the human body converts the male hormone testosterone into the more potent androgen dihydrotestosterone.

5-alpha reductase inhibitors are divided into:

synthetic (finasteride);
of plant origin (Serenoa repens preparations).

These are basic drugs for the conservative treatment of benign prostatic hyperplasia. There are other herbal preparations, for example, tadenan, trianol.

Others include: polyene antibiotics, such as mepartricin, levorin, amino acid complexes - balomethane, paraprostin, animal organ extracts - roveron.

For standard drug treatment of benign prostatic hyperplasia, 5-alpha reductase inhibitors (blockers) are often used. It has been proven that the intracellular enzyme of this compound converts testosterone into its active form - dihydrotestosterone. Ultimately, testosterone is metabolized not into dihydrotestosterone, but into estradiol or androstenedione. The prostate gland no longer enlarges.

In practice, finasteride is most often used among 5-alpha reductase inhibitors. It does not give side effects that often cause hormonal drugs.

The dosage is usually 5 mg per day.

After a month of use, patients experience a decrease in dihydrotestosterone levels. After 3 months, the prostate gland decreases in volume.

The most important thing is that the general well-being of patients improves. Quite often, as a result of long-term therapy with finasteride, there is no need for surgical intervention.

Side effects

Side effects when taking finasteride:

Potency disorders;

Decreased libido;

Reducing the volume of ejaculate;

A decrease in the level of a specific antigen in the blood serum.

You need to focus on point 4 when diagnosing prostate cancer.

The incidence of side effects decreases significantly with longer use of finasteride, a period of three or four years is required.

The basis of the 5-alpha reductase blocker from herbal products is the extract of the American fan palm (Serenoa repens). This extract is part of such drugs as Permixon, Prostagut, Serpens. Pygeum africanus extracts - containing Tadenane and Trianol.

Important note: with long-term use of these drugs, their therapeutic effect is reduced to almost zero, and something like addiction occurs. This effect is achieved by almost all herbal-based drugs, and not only from the field of urology.

As a result of treatment, it is necessary to achieve stable remission and increase the patient’s immunity.

There is no clear scientific basis for herbal preparations in the treatment of benign prostatic hyperplasia, since there is a lack of sufficient data and documented research results.

Contraindications to the use of 5-alpha reductase inhibitors:

There are contraindications to the use of 5-alpha reductase inhibitors:

presence of scars after surgery;

acute inflammatory process;

malignant neoplasms of the prostate gland;

severe renal failure.

If the patient has the above contraindications, then in order to improve the quality of his life and, if necessary, drug therapy, the selection of drugs is made individually, taking into account the results of a thorough examination.

All processes occurring in the human body require the participation of biologically active substances.

The latter also include enzymes, for example, 5-alpha reductase. Many people are familiar with this name from advertising.

What is this enzyme and in what cases is it recommended by doctors? These are the questions most readers are interested in. And that’s right, before taking any medicine, you need to find out how it affects the body. You should also not forget about the consequences of therapy, side effects and contraindications.

First of all, we will find out what functions 5 alpha reductase performs and give a definition to this substance. This is a protein compound, its enzyme is involved in the processes of steroidogenesis.

Functions of 5 alpha reductase:

stimulation of the conversion of male sex hormones into more intense dihydrotestosterone;

participates in the formation of allopregnanolone and other neurosteroids.

5-alpha reductase is produced mainly in the organs of the reproductive system (seminal vesicles, prostate tissue). This enzyme is produced in small quantities by skin cells, hair follicles, and some parts of the nervous system.

What are inhibitors for?

Drugs of this group block the production of this enzyme. This affects the amount of male sex hormones.

5-alpha reductase inhibitors are widely used as drugs to treat:

acne;
alopecia (intense hair loss);

The positive results of therapy have been confirmed by scientific studies.

Herbal preparations

Many patients prefer. It’s easy to explain - they act gently on the human body and do not cause damage to it. Such medications are often used to treat the prostate gland.

Fruits of dwarf palm of different levels of maturity

Alopecia and acne are also often treated with herbal preparations. To combat hyperplastic phenomena in the prostate, the fruits of the dwarf palm are often used. They contain a large amount of phytosterols and fatty acids. Only ripe fruits are used for medicinal purposes.

Products made from the fruits of the dwarf palm are used as a diuretic, tonic for the treatment of:

prostate gland;
Bladder;

In nature, this plant is found on the southern coasts of America. Its second name is . The Indians used the fruits of the dwarf palm not only to treat the urethra, prostate, and bladder.

It was used for bronchitis and pulmonary tuberculosis. When a man was underweight and a woman had small breasts, healers offered them black sabal berries, and this made it possible to get rid of problems very quickly.

There is another group of substances that have antiandrogenic properties. They are called isoflavones. A high content of such substances was found in stinging nettle. The properties of this plant have been known since ancient times. Our ancestors washed and rinsed their hair with nettle decoctions.

In order for village healers to infuse nettles in water.

This medicine is effective, fast-acting and harmless. In order for nettles to bring maximum benefits, they need to be collected in May.

To prevent many diseases, salads and green soups are prepared from young nettles. Now shampoos and conditioners are produced based on this plant, since it has a beneficial effect on hair growth and appearance.

Synthetic origin

These drugs provide a pronounced effect in the fight against diseases, but they are dangerous due to side effects.

For the manufacture of 5-alpha reductase inhibitors, 2 main active ingredients are used:

dutasteride (selective inhibitor), which is used to treat. The drug Avodart should be mentioned here;
Finasteride is a synthetic substance that reduces the level of enzymes in the blood and in the prostate itself. The effect of taking it lasts almost 24 hours.

Finasteride is also used for treatment, but patients should not hope for its 100% effectiveness. It has not been confirmed by research. Much more drugs based on finasteride are known. These include Alfinal, Finast, Proscar, Zerlon, Penester, Urofin, etc.

Side effects

Synthetic 5-alpha reductase blockers should be taken with extreme caution. They have a direct effect on human hormonal levels.

Long-term use of the drug can negatively affect the patient’s sex life. Patients note a decrease and impaired potency.

During sexual intercourse, the following problems may arise: unstable erection, sexual intercourse of insufficient duration, small volume of ejaculate, and an increase in the size of the mammary glands.

The amount of neurosteroids also decreases, which can lead to prolonged depression. However, such a side effect is isolated cases. All of the above means that such therapy must be carried out under the supervision of a doctor.

The use of 5-alpha reductase of synthetic origin requires specialist supervision, this will make it possible to avoid unwanted side effects.

Side effects that can occur when using synthetic drugs frighten patients. Many of them choose herbal medicines. However, these drugs also have negative properties. The human body quickly gets used to them, as a result of which the effectiveness of the medicine gradually decreases.

Contraindications

This drug, which suppresses enzyme activity, cannot be used for treatment in all patients.

A contraindication is the presence of acute inflammatory processes in the body, which include and.

Before starting to take this medicine, the patient must undergo a detailed examination of the body. At the slightest suspicion of oncology, he is prescribed.

The postoperative period and renal failure are also contraindications for the use of this drug.

Some application features

When visiting a doctor, the patient should be extremely frank, especially for young men.

The doctor should have no doubts when prescribing 5-alpha reductase.

If the patient plans to have a child in the near future, it is better to avoid taking this drug. Otherwise, the medicine may provoke the development of the fetus with pathologies.

Conservative therapy for benign prostatic hyperplasia (BPH), or prostate adenoma, is prescribed to men with mild to moderate clinical manifestations. According to the international scale for assessing symptoms of prostate diseases, this ranges from 8 to 18 – 19 points.

It should be noted that the number of patients with prostate hyperplasia is increasing every year, which is associated with an increase in life expectancy.

Table of contents: Indications for drug treatment of prostatic hyperplasia Alpha-1-blockers Inhibitors of 5-phosphodiesterase Inhibitors of type 2 alpha-reductase 5 Anticholinergics Herbal medicine and nutritional supplements - American dwarf palm - African plum tree - Rye - Pumpkin seeds - Prostatilen Indications for drug treatment prostatic hyperplasia

Indications for conservative therapy:

the sum of points on the quality of life scale is at least 3;
maximum flow rate of at least 5ml/sec;
the amount of urine excreted at one time is at least 100 ml;
residual urine volume is less than 150 ml;
concomitant severe pathology, which does not allow surgery due to the high risk.

The tactics of dynamic observation are practiced with a mandatory blood assessment for PSA and control TRUS once a year.

Drugs for the treatment of BPH began in the mid-1970s with the use of non-selective alpha blockers. With the development of pharmacology, drugs for adenoma have evolved into modern alpha-1-blockers, which are considered first-line drugs.

The action of drugs for BPH is aimed at the following aspects:

reduction/elimination of lower urinary tract disorders;
prevention of complications (acute urinary retention, renal hydronephrosis, chronic recurrent inflammatory processes, chronic renal failure, etc.);
improving quality of life.

We recommend reading: Prostate adenoma: symptoms, causes, treatment Alpha-1 adrenergic blockers

In the symptoms of adenoma associated with dysuric disorders, a special role belongs to smooth muscle tension in the stroma of the prostate, prostatic part of the urethra and bladder neck, which is supported by alpha-1 receptors. Blockade of these receptors leads to relaxation of smooth muscle structures and improvement of the quality of the urine stream.

There are three receptor subtypes: 1a, 1b and 1c. Of these, the largest number of alpha-1-a receptors is concentrated in the bladder neck and prostate. It is these receptors that are selectively affected by drugs based on silodosin and tamsulsin.

Silodosin (Urorek) is considered the most uroselective of modern drugs for adenoma due to its high affinity for the alpha-1a receptor subtype. It began to be used in 2008.

Taking Doxazosin and Terazosin is dose-dependent, i.e., it is necessary to select an individual dosage. The maximum permissible dose has not been determined, but it is believed that the higher it is, the greater the likelihood of developing side effects. So, side effects may be as follows:

orthostatic hypotension (drop in blood pressure);
dizziness;
fatigue;
ejaculation disorders;
nasal congestion.

Currently, Doxazosin and Terazosin are prescribed less frequently, as there are more effective drugs. The average dose is 2 – 4 mg/day.

Silodosin (Uroreka) is currently considered the preferred alpha-1-blocker.

Take it 8 mg once a day for a long time.

The number of patients with the development of arterial hypotension while taking Silodosin is only 1.3%, while the placebo effect is 1%.

The drug is safe when administered concomitantly with antihypertensive drugs in patients with arterial hypertension.

The minimal effect of Silodosin on blood pressure levels is considered a significant advantage.

During treatment with Silodosin, repeated survey results show a decrease in the total number of points by 4 - 6 and an increase in the maximum urine flow rate by 20%. Symptoms of bladder outlet obstruction decrease by 30.5% from the original, with Tamsulosin - by 14.7%.

The advantages of Silodosin compared to Tamsulosin include the speed of development of the therapeutic effect: the rapid onset of action makes it possible to use the drug even in patients with acute urinary retention due to BPH.

After 2 - 6 hours from the moment of consumption, the average urine flow rate increases by 2.8 ml/sec. The positive effect remains throughout the entire therapy.

The first IPSS test can be carried out as early as a week after starting treatment.

If a combined treatment regimen using phosphodiesterase-5 inhibitors (tadalafil, sildenafil) is planned, then there is a possibility of dizziness.

Co-administration with antihypertensive drugs can lead to orthostatic hypotension in 1.4% of cases.

Ejaculation disorders are more often caused by taking Tamsulosin or Silodosin in relatively young patients with preserved sexual activity.

Tamsulosin is prescribed once a day, 0.4 mg, for a long time. Some patients can take these drugs for life, provided they are well tolerated.

Patients who took Alfuzosin or placebo did not experience problems with ejaculation.

In the treatment of prostate hyperplasia there are the following groups of drugs:

non-selective alpha-blockers: Phenoxybenzamine (no longer used);
short-acting selective alpha-1 blockers: Prazosin, Alfuzosin, Indoramin;
long-acting selective alpha-1 blockers: Terazosin, Doxazosin;
long-acting selective alpha-1 a-blockers: Silodosin, Omnic, Omnic-Ocas (gradual release), Fokusin, Proflosin;
5-phosphodiesterase inhibitors: Cialis, Levitra;
5 alpha-reductase type 2 inhibitors.

5-phosphodiesterase inhibitors

Statistically significant symptomatic improvements have been reported in patients receiving Tadalafil, Vardenafil or Sildenafil. These drugs have been approved for the co-treatment of BPH and erectile dysfunction. Phosphodiesterase 5 inhibitors help relax the smooth muscles of the lower urinary tract.

For most men diagnosed with benign prostatic hyperplasia, it is important to maintain sexual activity while undergoing conservative therapy. 33% of patients report dissatisfaction with the quality of spontaneous erections, which is associated with taking medications. The inclusion of Tadalafil, Vardenafil or Sildenafil in the regimen significantly improves the quality of life and helps to normalize not only the urine stream, but also erectile function.

Names: Cialis, Levitra, Viagra.

Type 2 alpha-reductase 5 inhibitors

5 alpha-reductase type 2 inhibitors block the conversion of testosterone to dehydrotestosterone by blocking the enzyme, as a result of which cell proliferation slows down.

5-alpha reductase inhibitors relieve dysuric disorders by reducing the volume of the prostate gland. To achieve the best possible result, taking the drugs for a long time, at least 6 months.

Representatives: Finasteride and Dutasteride.

As a result of the use of Finasteride (Finast, Proscar) and Dutosteride (Avodart), the level of dehydrotestosterone is blocked by 80%, the number of urinations is reduced and the intensity of symptoms of lower urinary tract obstruction decreases. At the same time, there are side effects, which include decreased libido, erectile dysfunction, ejaculation disorders, and gynecomastia).

Conducted studies have shown that both drugs are equally effective in the treatment of benign prostatic hyperplasia.

Disadvantages include the duration of administration before the development of a therapeutic effect.

The number of side effects during combination therapy is higher, therefore, its use is not justified for the treatment of patients with mild symptoms of urinary disorders due to prostate adenoma.

There is evidence that after 2-4 years of use of 5-alpha reductase inhibitors, prostate volume decreased by 1/3 - 1/4, and the maximum urine flow rate increased by 1.5 - 2.0 ml/sec. Take 5 mg 1 time per day orally for up to 6 months.

Alpha-1 receptor blockers provide rapid relief of symptoms, while 5-alpha reductase inhibitors help reduce prostate size. In drug therapy for urinary disorders due to BPH, studies have demonstrated that combination therapy reduces the risk of adenoma progression, the development of acute urinary retention, the likelihood of surgery, and more effectively combats the symptoms of BPH.

The duration of the course of treatment is determined individually in each case: for moderate symptoms it is 6 months; in patients with severe urinary disorders, longer treatment is possible.

Anticholinergics

Anticholinergic drugs are now practically not used due to the high likelihood of developing acute urinary retention.

We recommend reading: Remedies for the treatment of prostate adenoma Herbal medicine and nutritional supplements

Most herbal medicines are made from the roots, seeds or fruits of the plants listed below:

palmetto;
African plum;
stinging nettle;
rye;
pumpkin seeds.

Some of the proposed components contain phytosterols, fatty acids, pectins, flavonoids, vegetable oils and polysaccharides.

There are preparations that contain components of only one plant, while others contain several.

Suggested effects of plants on BPH:

It is possible to take herbal medications for adenoma, since no undesirable effects have been recorded.

American dwarf palm

Palmetto berry extract is the most popular herbal remedy for BPH. The active ingredients are considered to be components represented by fatty acids, phytosterols and alcohols. Mechanism of action:

antiandrogenic effect;
5-alpha reductase inhibition;
anti-inflammatory effect.

The recommended dose is 160 mg orally 2 times a day. Studies have not been large, but some show subjective improvement in symptoms without improvement in objective urodynamic parameters.

Clinical trials are ongoing.

African plum tree

Proposed mechanisms of action include fibroblast growth inhibition, anti-inflammatory and anti-estrogenic effects. Further research is being carried out.

Rye

The extract is obtained from rye pollen, which grows in southern Sweden. The proposed mechanisms of action are as follows:

blockade of alpha-1 receptors;
increased zinc levels in prostate tissues;
inhibition of 5-alpha reductase activity.

There is evidence of significant symptomatic improvement compared with placebo.

Pumpkin seeds

Large-scale studies have shown that pumpkin seeds can reduce urinary frequency and urgency associated with prostate adenoma.

There are practically no side effects.

Proposed mechanisms: increased synthesis of prostaglandin due to the content of a large amount of linoleic acid and the anti-inflammatory effect of gamma-tocopherol and nitric acid.

Contraindications to drug treatment:

suspected prostate cancer;
cicatricial process in the pelvis;
median lobe;
cystolithiasis;
recurrent hematuria;
neurogenic bladder;
hypersensitivity reactions to specialized drugs;
renal failure supported by prostate hyperplasia.

Prostatilen

Prostatilen, Prostacor, Vitaprost, Vitaprost plus, Vitaprost forte are drugs that are used only in Russia. Large-scale studies have not been conducted, but many experts believe that there is an effect after use in combination with first-line medications.

The working component is a complex of peptides isolated in a special way from the bovine prostate gland.

The active substance is believed to have the following actions:

organotropic;
anti-inflammatory;
decongestant;
antiplatelet;
normalizing erectile function;
helping to improve microcirculation, etc.

There is evidence that the use of Vitaprost Forte suppositories daily, for a month, once a day, even as monotherapy, improves the quality of life and alleviates the symptoms of BPH.

Victoria Mishina, urologist, medical columnist

okeydoc.ru

When a patient presents with certain symptoms, the urologist must conduct a series of tests before prescribing specific medications to treat the disease. The main indications for alleviating the condition of a patient with prostate adenoma include:

small tumor size;
slight changes in urination rate;
the volume of residual fluid in the bladder after visiting the toilet does not deviate very much from the norm.

Drug treatment is carried out only at the initial stage of the formation of prostate adenoma. In more advanced cases, the drugs will not be effective. Surgery will be required.

Currently, medications are prescribed for prostatitis and prostate adenoma that have a targeted effect on the pathology and have minimal effect on other organs. The list of the main means of combating adenoma at the initial stage includes:

alpha receptor blockers;
inhibitors of the production of an enzyme that affects the production of steroids (5-alpha reductase);
traditional medicines.

These drugs cope well with the problem in combination with other therapeutic methods. Their action is based on suppressing the growth of tumor cells. Medicines for the treatment of prostate adenoma produce a good effect: they normalize the functioning of the urinary tract, balance hormonal levels, accelerate metabolism and have a positive effect on blood circulation in the prostate. In addition to combating the growth of adenoma, these drugs help increase potency.

Having assessed the patient’s condition and the nature of the disease, the doctor prescribes a medicine for prostate adenoma in one of the existing forms: intravenous or intramuscular injections, tablets or coated powder (capsules), suppositories for rectal use, suspensions, decoctions.

The development of prostate adenoma at the initial stage is almost imperceptible. Sometimes the tumor is discovered only after two or three years. Therefore, men should be very wary of the health of their genitourinary system and consult a doctor at the slightest symptoms. If the diagnosis is made in a timely manner, surgery can be avoided by limiting the use of medications.

Effective drugs for prostatitis are alpha-blockers:

Omnic

This is the most commonly prescribed treatment for prostate adenoma. The drug is safe for the body. Its action is aimed at changing the tone of the bladder muscles and normalizing the process of urine excretion. The medicine does an excellent job of getting rid of incontinence and preventing its recurrence.

Doxazosin

The tablets normalize blood pressure and dilate blood vessels, reducing the frequency of urges at night. This medicine has a long-lasting effect and is often used as a pain reliever for prostate adenoma.

Therazonin

The drug is prescribed to influence the tone of the smooth muscles of the urethra and reduce the volume of stagnant urine.

Alfuzonin

It specifically affects the receptors of the prostate gland and bladder, facilitates the outflow of fluid and inhibits the growth of adenoma cells.

The general health-improving effect of drugs based on alpha-blockers is manifested as follows:

the tone of the smooth muscles of the genitourinary organs becomes better;
the lumen of the urethra increases;
the volume of adenoma is significantly reduced;
a more powerful and continuous stream is observed during emptying;
stagnation of urine in the bladder becomes minimal.

The main symptoms of the disease begin to subside almost immediately after the doctor prescribes drugs for the treatment of prostate adenoma. But a long-term stable effect occurs only after 2-3 weeks. If relief does not occur after three months, the urologist cancels the medications in this group, since they are not suitable for this patient.

Side effects from taking alpha-blockers to reduce prostate adenoma are minimal: dizziness due to a decrease in blood pressure, a slight decrease in muscle tone and increased heart rate.

These prostate adenoma medications are used to stimulate testosterone production. This hormone strongly suppresses the growth of the tumor and, as a result, solves the problem with urination.

5-alpha reductase is a combination of proteins that stimulates the production of steroids and converts the main male sex hormone into dihydrotestosterone. This leads to the proliferation of prostate tissue and adenoma and even their degeneration into malignant tumors.

There are three main medications that are prescribed to relieve the symptoms of a disease such as adenoma.

Finasteride tablets effectively reduce the concentration of dihydrotestosterone, which helps reduce prostate tumors and improve urinary flow. The effect becomes noticeable within 8 hours after taking the medicine. The course of treatment is three months. But even after the same time after its completion, the adenoma returns to its previous size.

The drug in capsule form is prescribed for prostate adenoma to men of any age. It eliminates the causes of a sharp deterioration in urine output and suppresses tumor growth. The maximum effect of the medicine occurs one and a half to two weeks after the start of treatment.

A medicine based on finastride in the form of white tablets reduces the percentage of dihydrotestosterone in the blood a day after the first dose. The volume of the prostate gland is reduced after 3 months, a normal stream of urine is restored after another month, and the patency of the urinary canal improves significantly after 7 months, provided that the drug is taken continuously.

Medicines based on 5-alpha reductase inhibitors are so strong that they help patients even with the second stage of prostate adenoma. According to studies, most patients experience elimination of prostate tumor symptoms within 2 weeks. However, for a longer-term result, a continuous course of about six months is needed. In this case it is expected:

reduction of the volume of the adenoma and the prostate gland itself;
elimination of unpleasant symptoms when urinating;
reducing the risk of transformation of a benign tumor into a malignant formation.

There are a number of contraindications. Medicines with inhibitors are prohibited from being taken at the slightest suspicion of cancer. In this case, a biopsy is first done, and based on its results, the appropriate medicine is determined. You cannot take the medicine for prostate adenoma during inflammatory processes and with prostatitis. Kidney disease and the recovery period after surgery also do not allow the possibility of taking 5-alpha reductase blockers.

Such potent drugs for prostate adenoma after long-term use cannot but affect the functioning of the body as a whole. They imply a very serious intervention in a man’s hormonal balance.

First of all, the quality of life of patients suffers. The desire to have sexual intercourse decreases, erections often disappear and the duration of the act is noticeably reduced. This can lead to depression.

In addition, an effective medicine for prostate adenoma based on inhibitors provokes unpleasant allergic reactions, such as an itchy rash, urticaria or urticaria, and Quincke's edema. There is swelling and increased sensitivity of the mammary glands.

It is believed that medicine for prostatitis and adenoma based on natural ingredients does not harm a man’s health. Indeed, they have minimal side effects. In addition, such drugs even improve the quality of the patient’s sex life.

The most common medications are:

Gentos

Homeopathic drops based on natural ingredients. They are used strictly as prescribed by a doctor for the treatment of inflammatory processes of the genitourinary system.

Speman

Brown tablets contain 9 active ingredients. This is an excellent drug for prostate adenoma, the only side effect of which is the likelihood of allergic reactions.

In addition to eliminating problems with urination, patients note an increase in potency, an increase in ejaculate volume and an increase in the speed of sperm movement. This is especially important for those who are planning to have children.

Afala

The most popular medicine for prostate adenoma in tablet form. The drug has a wide spectrum of action.

Excellent fight against the growth of benign tumors even at the second stage.
Reduces pain during inflammatory processes.
Expands the urethra, reduced under the influence of adenoma.
Eliminates excessively frequent urge to empty the bladder.

This medicine, despite its homeopathic nature, should only be taken as prescribed by a doctor. The urologist must also calculate the correct dosage and course of treatment depending on the patient's condition. Self-administration of Afala can lead to an overdose.

Natural remedies for prostate adenoma have proven themselves well. But when treating with these medications, as well as with synthetic drugs, it is necessary to see a doctor. Regularly visiting a urologist and conducting research will help avoid dangerous tumor growth. Therefore, it is possible to avoid surgical intervention.

Recently, medications that combine the properties of alpha receptor blockers and 5-alpha reductase inhibitors have been gaining popularity. They are much more effective than single drugs, but the side effects are much more pronounced.

Among the most common products is Sonirid Duo. This medicine is prescribed only for significantly enlarged prostate adenoma (from 40 cubic cm). This medicine slows down the process of pathological tissue proliferation. Thus, the need for surgery is reduced.

During treatment of a man with a combination drug, women of childbearing age and pregnant women are strictly prohibited from contacting the components of the drug. When having sexual intercourse, you must use condoms.

Medicines aimed at combating pathogens are often prescribed to patients suffering from prostate adenoma. Stagnation of urine leads to inflammatory processes in the genitourinary organs. Gentamicin or Levorin are most often prescribed.

Men's attentive attitude to their health is necessary in order to avoid surgery to remove prostate adenoma. Medicines based on various components are selected by the doctor individually and act specifically on the problem. The sooner the patient contacts a specialist, the more gentle treatment he will be prescribed.

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5-alpha reductase in the human body converts the male hormone testosterone into the more potent androgen dihydrotestosterone.

5-alpha reductase inhibitors are divided into:

synthetic (finasteride);
of plant origin (Serenoa repens preparations).

These are basic drugs for the conservative treatment of benign prostatic hyperplasia. There are other herbal preparations, for example, tadenan, trianol.

Others include: polyene antibiotics, such as mepartricin, levorin, amino acid complexes - balomethane, paraprostin, animal organ extracts - roveron.

In practice, finasteride is most often used among 5-alpha reductase inhibitors. It does not give side effects that often cause hormonal drugs.

The dosage is usually 5 mg per day.

After a month of use, patients experience a decrease in dihydrotestosterone levels. After 3 months, the prostate gland decreases in volume.

The most important thing is that the general well-being of patients improves. Quite often, as a result of long-term therapy with finasteride, there is no need for surgical intervention.

Side effects when taking finasteride:

Potency disorders;

Decreased libido;

Reducing the volume of ejaculate;

A decrease in the level of a specific antigen in the blood serum.

You need to focus on point 4 when diagnosing prostate cancer.

The incidence of side effects decreases significantly with longer use of finasteride, a period of three or four years is required.

As a result of treatment, it is necessary to achieve stable remission and increase the patient’s immunity.

There is no clear scientific basis for herbal preparations in the treatment of benign prostatic hyperplasia, since there is a lack of sufficient data and documented research results.

Contraindications to the use of 5-alpha reductase inhibitors:

There are contraindications to the use of 5-alpha reductase inhibitors:

presence of scars after surgery;

acute inflammatory process;

malignant neoplasms of the prostate gland;

severe renal failure.

healthprostata.ru

5-alpha reductase: what is it?

First, it’s worth understanding the basic functions of the substance. 5-alpha reductase is a protein compound whose enzyme takes part in the processes of steroidogenesis. This substance stimulates the conversion of testosterone (male sex hormone) into dihydrotestosterone, which has a more intense effect. In addition, the enzyme promotes the formation of allopregnanolone and some other neurosteroids.

5-alpha reductase is produced mainly in the organs of the reproductive system, in particular in the tissues of the prostate gland and seminal vesicles. Small amounts of the enzyme are also produced in skin cells, hair follicles and some parts of the nervous system.

Why are inhibitors needed?

5-alpha reductase inhibitors are drugs that block the production of this enzyme and affect the amount of male sex hormones in the body. Today, such drugs are widely used. For example, they are often prescribed to patients suffering from acne. Drugs in this group help prevent alopecia (baldness).

There are many applications for drugs that inhibit the production of an enzyme such as 5-alpha reductase. DHT (dihydrotestosterone) blockers are used to treat prostate hypertrophy. Taking medications correctly helps reduce the volume of the prostate due to inflammation.

The effectiveness of the therapy has been confirmed by numerous scientific studies conducted in world-famous laboratories.

5-alpha-reducase inhibitors: synthetic drugs

Today, in the manufacture of drugs in this group, two main active components are used:

1. Dutasteride is a selective inhibitor and is widely used for the treatment of benign prostatic hyperplasia. The most popular drug is Avodart.

2. Finasteride is a synthetic substance that causes a decrease in the level of enzymes not only in the blood, but also directly in the prostate tissue. The effect lasts about 24 hours. Sometimes it is even used in the treatment of prostate cancer, although its 100% effectiveness has not been proven. The choice of drugs that contain finasteride is much larger: Alfinal, Urofin, Finast, Proscar, Zerlon, Penester and some others.

Herbal medicines

Synthetic drugs can certainly provide a more pronounced effect. But plant-based preparations are used quite often - they have a gentler effect on the body and are practically harmless. Such remedies, by the way, are used not only for prostate diseases. They help fight baldness (including female alopecia) and acne.

To treat hyperplastic processes in the prostate, the fruits of the dwarf palm, which are rich in phytosterols and fatty acids, are widely used. Isoflavones are another group of substances that have antiandrogenic properties. By the way, stinging nettle also has similar properties. The plant's herb is widely used to strengthen hair.

Are there any possible side effects?

You should take 5-alpha reductase blockers with caution, especially if we are talking about synthetic drugs. The fact is that these medications directly affect the patient’s hormonal levels.

With long-term use, many patients note changes in their sex life. In particular, there is a violation of potency and a decrease in sexual desire. Sexual contacts are often accompanied by problems: unstable erection, short-term sexual intercourse, etc. Side effects include a decrease in the volume of ejaculate. Due to the decrease in neurosteroids, patients develop depression, although this side effect is extremely rare.

Therapy must be carried out under the supervision of a doctor. If we are talking about herbal preparations, the body quickly gets used to them, so the effect of the medicine is gradually reduced to a minimum. On the other hand, herbal medicines are relatively safe for health.

Contraindications to the use of inhibitors

Not in all cases it is possible to take medications that suppress the activity of an enzyme called 5-alpha reductase. These drugs are not prescribed to patients with acute inflammatory diseases, including prostatitis.

Before drawing up a treatment regimen, it is necessary to undergo a complete diagnosis of the body. If cancer is suspected, a prostate biopsy is performed. The presence of malignant neoplasms is a contraindication to the use of the drug. Also, the medicine is not prescribed to patients during the postoperative period and in the presence of renal failure.

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E.I. Veliev, V.E. Ohritz
RMAPO, Department of Urology and Operative Andrology

Lower urinary tract symptoms (LUTS) are common in older men. In recent years, it has become clear that various pathophysiological mechanisms play a role in the occurrence of LUTS, but the dominant cause remains benign prostatic hyperplasia (BPH). It is known that BPH negatively affects the quality of life of most elderly men; in some patients, BPH takes a complicated course. Data from population-based studies suggest that DS is a progressive disease. Progression is expressed in worsening symptoms, acute urinary retention (AUR), which leads to the need for surgical intervention. In everyday practice, treatment of DSH usually begins with drug therapy; in case of its ineffectiveness, different surgical treatment options are used. The first choice drugs for BPH are alpha-blockers and 5-alpha reductase inhibitors. This article presents data on the mechanism of action, metabolic effects, and aspects of the use of 5-alpha reductase inhibitors.

Mechanism of action of 5-alpha reductase inhibitors

The growth of prostate tissue depends on the production of hormones and growth factors. Steroid 5-alpha reductase is an enzyme localized in the nuclei of prostate stromal cells that catalyzes the irreversible transformation of testosterone into dihydrotestosterone. Dihydrotestosterone binds to the nuclear androgen receptor in prostatic stromal cells and leads to the secretion of paracrine growth factors that diffuse from the stroma into the prostate epithelium, stimulating cell growth and differentiation. In a healthy prostate gland, homeostasis of proliferative and apoptotic processes in epithelial and stromal cells is maintained. To date, two isoenzymes of 5-alpha reductase have been discovered, differing in the chromosomal localization of genes, the pattern of expression in tissues and biochemical activity. Type 1 5-alpha reductase has little activity in prostate tissue and is present mainly in the skin and liver; type 2 5-alpha reductase is most often localized in the prostate gland. Both isoenzymes are detected in normal prostatic tissue, but in BPH they are overexpressed, which leads to hyperplasia of stromal and epithelial cells in the transition zone and paraurethral glands. In BPH, unlike prostate cancer, there is mainly an overexpression of type 2 5-alpha reductase. Excessive production of dihydrotestosterone can lead to androgen-dependent conditions such as benign prostatic hyperplasia (BPH), prostate cancer, acne, alopecia, etc. Thus, for the treatment of these conditions, the prescription of 5-alpha reductase inhibitors is pathogenetically justified. By blocking 5-alpha reductase, they reduce the concentration of dihydrotestosterone, induce apoptosis of prostatic epithelial cells, and with long-term use, reduce prostate volume by an average of 15-25% and increase peak urinary flow rate, thus eliminating the mechanical component of obstruction in BPH. Currently, two 5-alpha reductase inhibitors are registered on the pharmaceutical market: finasteride and dutasteride. Although both drugs have a similar mechanism of action, there are some pharmacological and clinical differences (Table 1). Finasteride was synthesized in 1984 and has been approved for use in the United States for the treatment of BPH since 1992. Finasteride is a competitive inhibitor of 5-alpha reductase, which has a much greater affinity for type 2 5-alpha reductase and forms a stable complex with the enzyme. At a daily dose of 5 mg/day, finasteride reduces the level of dihydrotestosterone in the prostate by 70-90%. The drug does not have androgenic or antiandrogenic effects and does not affect the interaction of testosterone and dihydrotestosterone with the androgen receptor. Comparative studies evaluating intraprostatic dihydrotestosterone concentrations with finasteride and dutasteride have not been conducted. According to approximate data, the intraprostatic concentration of dihydrotestosterone when using dutasteride is reduced by 94-95%, and when using finasteride - by 85-91%.

Table 1. Pharmacokinetic and pharmacodynamic differences between dutasteride and finasteride

Parameter	Dutasteride	Finasteride
Target of the drug action	Type 1 and 2 5-alpha reductase	Type 2 5-alpha reductase
Metabolism	Liver	Liver
Recommended daily dose	1 x 0.5 mg	1 x 5 mg
Bioavailability	60%	80%
Time of maximum serum concentration (T max)	1-3 h	2h
Half-life (T 1/2)	5 weeks	6-8 hours
Serum decrease in dihydrotestosterone concentration	94,7%	70,8%

Morphological and metabolic effects of 5-alpha reductase inhibitors

Dihydrotestosterone, the main factor in the exocrine secretion of prostatic epithelial cells, is a key substance for the formation of intraprostatic and serum PSA. Within 6-12 months of taking 5-alpha reductase inhibitors, serum PSA levels decrease by 50%. This must be taken into account when deciding whether to perform a prostate biopsy. It is believed that the criterion for prostate biopsy when taking 5-alpha-reductase inhibitors is an increase in serum PSA level more than 0.3 ng/ml from the nadir level. A large number of experimental and clinical studies have shown that 5-alpha reductase inhibitors reduce prostate volume and induce atrophy and apoptosis of epithelial cells in BPH. There is growing evidence that similar effects are observed in prostate cancer. Finasteride dose-dependently reduced cancer cell proliferation in LNCaP cell lines. These data have prompted a large number of studies on the use of 5-alpha reductase inhibitors in RP. Importantly, finasteride reduces the expression of vascular endothelial growth factor (VEGF), inhibiting angiogenesis and significantly reducing microvascular density in prostatic suburethral tissue, which explains the effectiveness of finasteride in BPH complicated by hematuria and less blood loss in TURP of the prostate after drug therapy.

In recent years, the issue of the effect of finasteride on spermatogenesis and the safety of the drug in men whose sexual partners are pregnant has been discussed. As mentioned above, finasteride has been approved for use in BPH since 1992, and since 1997, finasteride has been widely used for the treatment of alopecia at a dose of 1 mg per day. This has led to an increasing number of men of reproductive age using finasteride. A number of studies have shown that when 1 mg of finasteride is prescribed, the concentration of sperm, their motility and morphological characteristics do not change. Similar data were obtained in a study of a dose of 5 mg. In the United States, the possibility of accumulation of 5-alpha-reductase inhibitors in sperm and a possible teratogenic effect on the fetus of a pregnant partner has been widely discussed. Finasteride concentrations in semen with a daily dose of 5 mg ranged from undetectable to 21 ng/ml. Thus, 5 ml of ejaculate contains a dose of finasteride that is 50-100 times less than that taken orally, and is unlikely to have any effect on the fetus. However, men whose partners are pregnant are advised to take finasteride with caution. Although 5-alpha reductase inhibitors do not have antiandrogenic effects, concerns have been raised about possible negative cardiac and bone-resorptive effects of treatment. Placebo-controlled studies have shown that therapy with 5-alpha reductase inhibitors does not affect bone density, bone resorption markers, lipid and carbohydrate profiles, or hemoglobin concentration. 5-alpha reductase inhibitors are generally well tolerated and cause few side effects. Most adverse reactions are observed in the first year of therapy, and most often this does not lead to refusal of treatment. The incidence of side effects when taking dutasteride and finasteride does not differ. In a 12-month study of the side effects of dutasteride (813 patients) and finasteride (817 patients), erectile dysfunction was recorded in 7% and 8% of patients, respectively, decreased libido - in 5% and 6%, respectively, ejaculatory disorders - in 1% in each group and gynecomastia - also in 1% in each group.

Efficacy of monotherapy with 5-alpha-reductase inhibitors in the treatment and prevention of progression of BPH

Finasteride is the most studied 5-alpha reductase inhibitor. Boyle et al. performed a meta-analysis of six randomized placebo-controlled clinical trials. The most significant correlation was found between initial prostate volume and clinical improvement. When the initial prostate volume was less than 20 cm 3, a slight improvement was noted: the total score on the IPSS scale decreased by 1.8 points, and the urinary flow rate increased by 0.9 ml/s. If the initial prostate volume was more than 60 cm 3, the total score decreased by 2.8 points, and the urination rate increased by 1.8 ml/s. The difference between the placebo and finasteride groups was evident for prostate volumes greater than 40 cm 3 . The results of this meta-analysis were followed by the publication of 4-year data from finasteride in the PLESS study. When taking finasteride, prostate volume decreased by 18% compared to an increase of 14% in the placebo group, symptoms decreased in the IPSS questionnaire (3.3 points versus 1.3 points with placebo), and urinary flow rate increased (3.3 ml/s versus 1.3 ml/s).

Subsequently, the results of finasteride monotherapy in the MTOPS (Medical Therapy of Prostatic Symptoms) study became available - the median reduction in prostate volume in the finasteride group was 19% (versus an increase of 24% in the placebo group). There was also a significant improvement in urinary flow rate and a decrease in IPSS scores. In the 12-month EPICS (Enlarged Prostate International Comparator Study) study of finasteride and dutasteride, 1630 patients with symptomatic BPH over 50 years of age were randomized to finasteride (817 patients) or dutasteride (813 patients). After a year of therapy, on average, prostate volume decreased by 27.4% in both groups. There was no statistically significant difference in improvement in IPSS score and increase in Qmax between groups. The MTOPS study was the first double-blind, randomized, placebo-controlled trial to examine the effect of drug therapy on the progression of BPH. Clinical progression of the disease was defined as an increase in the total number of points on the IPSS scale > 4, the development of AUR, acute renal failure associated with BPH, recurrent urinary tract infections, and urinary incontinence. In the placebo group (737 men), clinical progression of the disease was recorded in 17% of patients during 5 years of observation. The most common manifestation of progression was subjective worsening of LUTS (increase in IPSS > 4) - 79.5%, AUR occurred in 2% of patients in the placebo group, surgery for BPH was required in 5% of patients. Over 5 years of follow-up, in the untreated group, prostate volume increased by 24% and PSA level by 14%. In the PLESS study, the risk of AUR decreased by 57% and the risk of surgery decreased by 55% in the group of patients taking finasteride. Dutasteride has demonstrated similar effectiveness in reducing the risks of AUR and the need for surgery. The risk of AUR with dutasteride decreased by 57%, and the risk of surgery decreased by 48% compared with placebo.

Efficacy of combination therapy with 5-alpha-reductase inhibitors in the treatment and prevention of progression of BPH

The prescription of combination therapy with a 5-alpha-reductase inhibitor and an alpha-blocker, which differ in their mechanism of action and complement each other, is pathogenetically justified. However, the first randomized trials did not demonstrate any benefit of combination therapy over alpha-blocker monotherapy at 12-month follow-up. In the PREDICT trial (doxazosin and finasteride) and the Veterans Affairs Cooperative Studies Benign Prostatic Hyperplasia Study (terazosin and finasteride), combination therapy was superior to 5-alpha-reductase inhibitor monotherapy but showed no benefit over alpha-blocker monotherapy. This may be explained by the short duration of therapy in this study. The results of the already mentioned MTOPS study, which included 3047 patients, confirmed the advantage of long-term (more than 4 years) combination therapy. Although the primary objective of the study was to examine progression of BPH with treatment, long-term combination therapy was found to be superior to monotherapy in both reducing LUTS and improving urinary flow rate. Over 4 years of treatment, the number of points on the IPSS scale decreased by an average of 4.9; 6.6; 5.6; 7.4 in the placebo, doxazosin, finasteride and combination therapy groups, respectively. Urination rate improved by 2.8; 4.0; 3.2 and 5.1 ml/s, respectively.

Thus, all types of therapy demonstrated an advantage over placebo, alpha-blocker therapy over treatment with a 5-alpha-reductase inhibitor, and combination therapy was the most effective. This important study also answered the question of the progression of BPH in different treatment groups. The risk of progression (worsening LUTS) was 66% lower in the combination therapy group compared with 34% and 39% in the finasteride and doxazosin monotherapy groups, respectively. At the same time, when assessing the risk of developing AUR and the need for surgical intervention, it turned out that it was finasteride, and not doxazosin, as mono- or combination therapy that significantly reduced both risks. The incidence of AUR during treatment was 0.2 cases per 100 patients in the finasteride group, 0.1 cases per 100 patients in the combination therapy group, 0.4 cases per 100 patients in the doxazosin group, and 0.6 cases per 100 patients in the placebo group. The incidence of surgical intervention for BPH during treatment was 0.5 cases per 100 patients in the finasteride group, 0.4 cases per 100 patients in the combination therapy group, 1.3 cases per 100 people in the doxazosin group and 1.3 cases per 100 patients in the placebo group. The researchers concluded that patients with LUTS and prostate volume greater than 30 cm 3 benefit from combination therapy compared with either monotherapy group.

The 4-year Comb AT study examined the effects of dutasteride, tamsulosin, and combination therapy on LUTS and BPH progression. The benefits of combination therapy compared with monotherapy have also been demonstrated. Table 2 presents summary data on the effectiveness of various drug combinations in the treatment of LUTS and BPH progression.

Table 2. Data from multicenter studies on the effectiveness of drug therapy and prevention of BPH progression

Study	Duration, months	Group	Number of patients	Change IPSS	Change Q	Change in OP, %	Surgery, %	OMV, %	Level of evidence
Andersen et al.	24	Placebo	2109	—	—	—			1b
Andersen et al.	24	Finasteride	2113	—	—	—	-34	-57	1b
McConnell et al.	48	Placebo	1503	-1,3	+0,2	+ 14			1b
McConnell et al.	48	Finasteride	1513	-3,3	+ 1,9	-18	-55	-57	1b
McConnell et al.	54	Placebo	737	-4	1,4	+24			1b
		Doxazosin	756	-6	2,5	+24	-3	-35
		Finasteride	768	-5	2,2	-19	-64	-68
		Combination therapy	786	-7	3,7	-19	-67	-81
Roehrborn et al.	24	Placebo	2158	-2,3	0,6	+ 1,5			1b
Roehrborn et al.	24	Dutasteride	2167	-4,5	2,2	-25,7	-48	-57	1b
Roehrborn et al.	24	Tamsulosin	1611	-4,3	0,9	0			1b
		Dutasteride	1623	-4,9	1,9	-28	—	—
		Combination therapy	1610	-6,2	2,4	-26,9	—	—
Roehrborn et al.	48	Tamsulosin	1611	-3,8	0,7	+4,6			1b

Possibility of switching to monotherapy with a 5-alpha-reductase inhibitor in patients with LUTS

5-alpha-reductase inhibitors must be prescribed over a long period of time to achieve clinical effect, whereas alpha-blockers achieve maximum effectiveness within a few weeks. The SMART (Symptom Management After Reducing Therapy) study examined the effectiveness of combination therapy with dutasteride and tamsulosin and the effect of tamsulosin withdrawal on LUTS after 6 months of treatment. After discontinuation of the alpha blocker, almost three quarters of patients did not complain of increased LUTS. However, in cases of initial severe urinary dysfunction (IPSS > 20), a long course of combination therapy was required. A recent open-label, multicenter study assessed the effectiveness of combination treatment with finasteride and an alpha-blocker for 9 months, followed by alpha-blocker discontinuation and finasteride therapy for 3 or 9 months. There was no significant worsening of LUTS after alpha-blocker discontinuation in either group. Thus, in patients with mild to moderate LUTS, after 6-9 months of treatment, it is possible to switch to monotherapy with a 5-alpha reductase inhibitor, while in patients with severe LUTS, it is advisable to continue long-term combination therapy.

5-alpha-reductase inhibitors for chemoprevention of RP

Clinical evidence for the role of 5-alpha-reductase inhibitors in the prevention of prostate cancer comes from the Prostate Cancer Prevention Trial and REDUCE (Reduction by Dutasteride of Prostate Cancer Events). PCPT began in 1993 in more than 200 centers in the United States. Mandatory selection criteria for the study were age over 55 years, PSA level. In the group receiving finasteride, the PSA value doubled. At the end of the study after 7 years, prostate biopsy was recommended for all patients. A total of 18,882 people were randomized. A 24.8% reduction in the incidence of low-grade prostate cancer was reported in the finasteride group. At the same time, an increased risk of low-grade cancer was detected in the finasteride group (280 tumors with high Gleason scores (7-10 points) in the finasteride group compared with 237 in the placebo group). This led to the conclusion that finasteride should not be used for chemoprophylaxis of RP. Great hopes were associated with the use of the dual 5-alpha reductase inhibitor dutasteride, the effect of which on the development of prostate cancer was studied in the REDUCE study. However, the study results demonstrated a similar decrease in the incidence of high-grade prostate cancer (22.8%) and a similar increase in the incidence of low-grade PCa. Several additional analyzes were performed to determine the true effect of 5-alpha reductase inhibitors on low-grade cancers. Unfortunately, these works were retrospectively analyzed, and the use of their results is possible only as assumptions and not clear evidence. In addition, only 27% of patients diagnosed with prostate cancer had morphological specimens available after surgery. In December 2010, a meeting of the FDA (Food and Drug Administration) consensus committee was held on the advisability of using 5-alpha reductase inhibitors for the prevention of prostate cancer. Pathological specimens from PCRT and REDUCE studies were evaluated by an independent pathologist using a modified Gleason score. However, after re-analysis of biopsies, there was no decrease in the incidence of prostate cancer with a Gleason score of 7 to 10 points, while at the same time there was an absolute increase in prostate cancer with a Gleason score of 8-10 by 0.5% with the use of dutasteride and on 0.7% when using finasteride. There was only a decrease in the incidence of prostate cancer with a Gleason score of 6 or lower. As a result, 5-alpha reductase inhibitors have not been recommended by the FDA for routine use in the prevention of prostate cancer. Undoubtedly, the studies conducted had a number of epidemiological and clinical features, and further research is needed to confirm or refute the value of 5-alpha reductase inhibitors in the prevention of prostate cancer.

Conclusion

The results of a number of multicenter, randomized, double-blind studies have confirmed the effectiveness of 5-alpha reductase inhibitors in the treatment of LUTS and the prevention of progression of BPH. Currently, clinical studies are underway of other types of combination therapy for BPH - 5-alpha-reductase inhibitors and M-anticholinergics, 5-alpha-reductase inhibitors and phosphodiesterase type 5 inhibitors. In addition, the co-administration of testosterone drugs and 5-alpha-reductase inhibitors in patients with symptoms of hypogonadism and LUTS due to BPH is being studied. In 2009, a multicenter study ARTS (Avodart after Radical Therapy for Prostate cancer Study) was launched, which studies the effectiveness of dutasteride in biochemical relapse after radical prostatectomy or radiation therapy for prostate cancer, as well as the possible benefits of prescribing 5-alpha reductase inhibitors for castration-refractory prostate cancer. In the problem of chemoprevention of prostate cancer with 5-alpha-reductase inhibitors, there are still many questions that need to be resolved by long-term studies. When comparing two 5-alpha reductase inhibitors, it should be noted that most studies have not demonstrated a clinical benefit of dutasteride in patients with BPH in improving LUTS and reducing the likelihood of disease progression. When used alone, finasteride reduces prostate volume by an average of 20%, which leads to a significant reduction in the mechanical component of obstruction in BPH. An additional advantage of finasteride is the effectiveness of the drug in the treatment of BPH complicated by hematuria, and the possibility of its use as a preparation for TURP of the prostate. Studies have also confirmed the significant benefit of using combination therapy with an alpha-blocker to prevent the progression of BPH, especially in patients with an enlarged prostate gland (more than 30 cm 3). The economic availability of finasteride compared to dutasteride allows us to recommend this drug for widespread use in the treatment of BPH.

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6. McConnell J.D., Bruskewitz R., Walsh P. et al. Proscar Long-term Efficacy and Safety Study The effect of Finasteride on the risk of acute urinary retention and the need for surgical treatment among men with benign prostatic hyperplasia. Finasteride Long-Term Effcacy and Safety Study Group // N. Engl. J. Med. 1998. Vol. 338. P. 557-563.
7. McConnell J.D., Roehrborn C.G., Bautista O.M. et al. The long-term effect of doxazosin, Finasteride, and combination therapy on the clinical progression of benign prostatic hyperplasia // N. Engl. J. Med. Vol. 2003 Vol. 349. P. 2387-2398.
8. Roehrborn C.G., Lukkarinen O., Mark S. et al. Long-term sustained improvement in symptoms of benign prostatic hyperplasia with the dual 5alpha-reductase inhibitor dutasteride: results of 4-year studies // BJU Int. 2005. Vol. 96. P. 572-577.
9. Cohen Y.C. et al. Detection bias due to the effect of finasteride on prostate volume: a modeling approach for analysis of the Prostate Cancer Prevention Trial // J. Natl. Cancer Inst. 2007. Vol. 99. P. 1366-1374.
10. Pinsky P., Fames H., Ford L. Estimating rates of true high-grade disease in the Prostate Cancer Prevention Trial // Cancer Prev. Res. 2008. Vol. L.P. 182-186.
11. Redman M.W. et al. Finasteride does not increase the risk of high-grade prostate cancer: a bias-adjusted modeling approach // Cancer Prev. Res. 2008. Vol. 13). P. 174-181..
12. Theoret M.R., Ning Y.-M., Zhang]. et al. The risks and benefits of 5a-reductase inhibitors for prostate-cancer prevention // N. Engl. J. Med. 2011. Vol. 365(2). P. 97-99.
13. Smith A.B., Carson C.G Finasteride in the treatment of patients with benign prostatic hyperplasia: a review // Therapeutics and Clinical Risk Management. 2009. Vol. 5. P.535-545.
14. Kaplan S., Lee], Meehan A. etal. Long-term treatment with Finasteride improves clinical progression of benign prostatic hyperplasia in men with an enlarged versus a smaller prostate: Data from MTOPS Trial // J. Urol. 2011. Vol. 185(4). P. 1369-1373.
15. Schroder F.H., Bangma C.H., Wolff J.M. et al. Can dutasteride delay or prevent the progression of prostate cancer in patients with biochemical failure after radical therapy? Rationale and design of the Avodart after Radical Therapy for Prostate Cancer Study // BJU International. 2009. Vol. 103 (5).R 590-596. 16. Bortolato M., Frau R., Orru M. et al. Antipsychotic-like properties of 5-a-reductase inhibitors // Neuropsychopharmacology 2008. Vol. 33. P. 3146-3156.

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Benign prostatic hyperplasia (BPH) is one of the most common urological diseases, especially among older men. Signs of the disease occur in 10-20% of men aged 40 years, and its proportion in men over 80 years of age is 80-90%.

Currently, there are several options for managing patients with BPH and associated symptoms of the lower urinary tract (LUTS): observation tactics, drug therapy and various surgical treatment methods, among which open and minimally invasive methods, including high-energy and endovascular, remain important. In the global urological community, indications for one or another method, including pharmacotherapy, are constantly discussed and adjusted annually. When planning drug therapy, it is necessary to determine the duration of treatment: lifelong use of drugs as the main method of treating the disease or a short course to prepare the patient for surgery.

The main objectives of pharmacotherapy for BPH:

· prevent the progression of the disease - stop the growth of the prostate gland;

· reduce the severity of clinical symptoms and improve the patient’s quality of life - reduce hypertonicity of the smooth muscle fibers of the prostate and posterior urethra, improve blood supply to the bladder, restore detrusor contractility and quality of urination.

When choosing a drug for drug therapy of BPH, the following factors must be taken into account: the patient’s somatic condition, the presence of indications for surgical treatment, the absence of suspicion of prostate cancer, the severity of obstructive and irritative symptoms, the degree of bladder outlet obstruction and urodynamic disorders, the presence of complications of BPH, the severity of the concomitant inflammatory process in the prostate gland, the patient’s level of sexual activity. It should also be remembered that the severity of the morphological signs of BPH (enlarged prostate size) does not always correlate with clinical manifestations.

Based on all of the above, the following indications for drug therapy for BPH have now been formulated: total IPSS score > 8, but< 19, QOL менее 4 баллов, Qmax не более 15 и не менее 5 мл/с, объём остаточной мочи не более 150 мл, выраженная сопутствующая патология, отказ пациента от оперативного вмешательства. Особое значение в контроле эффективности консервативной терапии при ДГПЖ-ассоциированных обструктивных СНМП имеет динамическое измерение скорости потока мочи с помощью урофлоуметрии .

Contraindications to drug therapy for BPH are: the presence of a “middle lobe” of the prostate gland according to imaging studies, suspicion of prostate cancer, signs of severe bladder outlet obstruction and a large amount of residual urine, neurogenic disorders, individual intolerance to drugs.

According to the Recommendations of the 4th WHO Consensus Committee on Prostatic Hyperplasia (Paris, July 2-5, 1997), the main drugs for the treatment of BPH are 5-α-reductase inhibitors and α-blockers. Tadalafil, a phosphodiesterase-5 inhibitor with the longest half-life, is also approved for the treatment of LUTS, but its pharmacodynamic mechanisms in BPH remain largely unclear and require further study.

Inhibitors 5-α -reductase

Drugs in this group act directly on the pathogenetic mechanisms of the disease. The prostate gland is a hormonal-dependent organ under the control of the hypothalamic-pituitary-gonadal system. 5-α-reductase is an enzyme that is located in the nuclei of prostate stromal cells and is responsible for the transformation of testosterone into dihydrotestosterone (DHT). The latter is the active tissue form of the hormone and mediates the androgenic effect on the prostate gland, stimulating cell proliferation and inhibiting their apoptosis. To date, 3 isoenzymes of 5-α-reductase have been identified: type I, which is characterized by extraprostatic localization (mainly present in the liver and skin); Type II, localized mainly in the tissue of the prostate gland and seminal vesicles, as well as the skin of the scalp; Type III, which is expressed everywhere. Normally, all three types of the enzyme are detected in organ tissue, but with BPH, they are overexpressed, which causes hyperplasia of stromal and epithelial cells and a violation of their ratio. A number of studies have shown that in BPH there is an overexpression of predominantly type II 5-α-reductase, in contrast to prostate cancer.

Thus, the prescription of 5-α-reductase inhibitors is pathogenetically justified. By disrupting the function of the enzyme, drugs in this group reduce the concentration of DHT, induce atrophy and stimulate cell apoptosis, which ultimately leads to a decrease in the size of the organ and the elimination of the mechanical component of bladder outlet obstruction.

There are 2 drugs in this group available for clinical use - finasteride and dutasteride. Each of them has a number of pharmacodynamic and pharmacokinetic features in relation to the other. Thus, finasteride blocks only type II and III 5-α-reductase, while dutasteride blocks all three types of enzyme. The half-life for finasteride is 6-8 hours, for dutasteride it is higher and is 3-5 weeks. Both drugs are metabolized in the liver and excreted in the feces. Long-term treatment reduces plasma DHT levels 6 months after treatment by 70% with finasteride and by 95% with dutasteride. At the same time, the concentration of DHT in the prostate gland decreases to a similar level (80-95%) in the case of using both drugs. The recommended daily dose is 0.5 mg for dutasteride and 5 mg for finasteride.

The effect of taking 5-α-reductase inhibitors appears 6-12 months after taking the drugs and consists of a decrease in prostate volume by an average of 18-28% and a decrease in serum PSA levels by approximately 50%. This fact must be taken into account when determining indications for prostate biopsy. There is evidence that the size of the prostate gland may further decrease with long-term treatment. After 2-4 years of treatment, 5-α-reductase inhibitors reduce the initial level on the IPSS scale by 15-30% and increase Qmax according to uroflowmetry by 1.5-2.0 ml/sec.

The effect of finasteride on clinical symptoms depends on the size of the prostate gland before treatment and has not been proven in patients with a prostate size less than 40 ml. At the same time, dutasteride, according to a number of authors, reduces IPSS and prostate volume and increases Qmax. in patients with an initial organ volume of 30 to 40 ml. Indirect comparisons between different studies have shown equivalent effectiveness of finasteride and dutasteride in patients with BPH. Comparative studies with α-blockers have shown that 5-α-reductase inhibitors reduce the severity of clinical symptoms more slowly. At the same time, it is the drugs of this group, and not α-blockers, that reduce the long-term risk of acute urinary retention and the need for surgical intervention.

The most significant negative effects of 5-α-reductase inhibitors are related to sexual function and include decreased libido, erectile dysfunction, and, less commonly, decreased semen volume. These phenomena develop in 6-8% of patients. As a rule, side effects appear in the first year of drug treatment and their severity does not increase in the future. In 1-2% of cases, gynecomastia develops.

Thus, multiple multicenter clinical studies have confirmed the effectiveness of this group of drugs. Data from most studies do not show significant advantages in the clinical effectiveness of one of the drugs over the other. However, the prescription of these drugs has a number of features and should be carried out in a certain category of patients. Treatment with 5-α-reductase inhibitors should be used in patients with moderately severe obstructive and irritative symptoms, with an enlarged prostate gland (> 40 ml) and an elevated PSA level (> 1.4 - 1.6 ng/ml). These drugs can be used in combination with other groups. The effect on serum PSA levels should be considered in prostate cancer screening studies. 5-α-reductase inhibitors can be used both in long-term therapy of BPH and in preparing the patient for surgery.

α - adrenergic blockers

Drugs from the group of α 1 -adrenergic receptor blockers are an important element of drug therapy for benign prostatic hyperplasia. The accumulated experience of clinical and fundamental research eloquently demonstrates the role of disturbances in sympathetic regulation in the pathogenesis of this disease.

α 1 -adrenergic receptors are localized in the bladder neck, prostatic urethra, capsule and stroma of the prostate gland. Their overexpression and stimulation naturally leads to hypertonicity of the smooth muscle elements of the lower urinary tract and, consequently, the formation of a functional (dynamic) component of bladder outlet obstruction. Relaxation of the muscular system as a result of blockade of α 1 -adrenergic receptors leads to a decrease in the intensity of obstructive symptoms of prostate adenoma.

Long-term bladder outlet obstruction leads to hypoxia of the muscular layer of the bladder and the gradual development of detrusor remodeling. There is an opinion that vasodilation of the cystic arteries under the influence of α 1 -blockers, reducing the degree of ischemia, can slow down or even stop this pathological process. In addition, their direct inhibitory effect on the adrenergic receptors of the bladder leads to the alleviation of irritative symptoms of BPH. In this regard, combination therapy with the simultaneous administration of M-anticholinergics (tolterodine, solifenacin, etc.) is pathogenetically justified.

The main group of patients with prostate adenoma are elderly men experiencing problems with erectile function. In this regard, of particular interest is the fact that blockade of the activity of α 1-adrenergic receptors, due to their expression in the wall of the penile arteries, has a pro-erectile effect. In a number of situations with BPH with concomitant erectile dysfunction, a therapeutic regimen using α 1 -blockers and phosphodiesterase isomer 5 (PDE-5) inhibitors has been recognized as promising. α1-blockers and PDE5 inhibitors in combination have a mutually synergistic effect on both lower urinary tract symptoms (LUTS) and sexual dysfunction.

α 1 -adrenergic receptors control the smooth muscle elements of the main human arteries, which is why the use of α 1 -adrenergic blockers is fraught with the development of cardiovascular complications, a classic example of which is orthostatic hypotension. The effectiveness of α-adrenergic blockers and the incidence of undesirable effects when taking them directly depends on their selectivity for the A-subtype of α 1 -adrenergic receptors. It is this feature that is fundamental in the internal classification of this group of drugs.

1. Selective α 1 -blockers: prazosin, alfuzosin, doxazosin, terazosin.

Drugs in this group have the same affinity for all subtypes of α 1 -adrenergic receptors, which is why postural hypotension and reflex tachycardia are relatively common when taking them. Terazosin and doxazosin differ positively from their analogues in their group in pharmacokinetic parameters, namely their half-life - it is 12 hours and 19-22 hours, respectively. This makes it possible to prescribe the drug once at night, which has two goals: to reduce the severity of nocturnal pollakiuria and at the same time reduce the risk of a collaptoid state.

2. Superselective α 1A-blocker: tamsulosin.

Tamsulosin has a 20-fold selectivity for α 1A adrenergic receptors. Due to this, tamsulosin has a significantly lower incidence of cardiovascular complications than its predecessors. Its half-life lasts up to 15 hours, however, if necessary, the effect of the drug can be extended when used in the form of special dosage forms - delayed-release capsules (Omnic Okas, Astellas, Japan).

3. Ultraselective α 1A-blocker: silodosin.

With the introduction of tamsulosin into clinical practice, the search for an alternative α-blocker with the highest uroselectivity did not stop. The medicinal substance silodosin was developed, which is present on the Russian market as the drug “Urorek” (Recordati, Italy). This feature makes Urorek optimal in terms of its effect on systemic hemodynamics.

To summarize, it is necessary to emphasize the positive and negative aspects of the use of α-blockers for benign prostatic hyperplasia. These drugs are characterized by a rapid onset of effect with regression of symptoms, mainly irritative, and inhibit the process of detrusor remodeling. The rapid achievement of effect allows the use of adrenergic blockers for acute urinary retention. They interact synergistically and work well in combination with M-anticholinergics and PDE5 inhibitors. Selective α-blockers do not have a negative effect on libido, erectile function or the ability to achieve orgasm, and a number of studies even demonstrate their pro-erectile properties. The hypotensive effect of α-blockers can sometimes be beneficial in patients with concomitant hypertension.

The effect of using α-blockers is unstable and persists only with constant use. They affect only the dynamic component of bladder outlet obstruction, without affecting the organic one, since they do not lead to a decrease in the size of the prostate. Relaxation of the muscles of the seminal vesicles leads to ejaculation disorders while maintaining orgasm. There are side effects such as orthostatic hypotension and nasal congestion, although this problem is partially resolved with uroselective drugs.

Conclusion. Each of the considered groups of drugs for the treatment of BPH has its own advantages and disadvantages. 5-α-reductase inhibitors act slowly, but have a lasting effect, reducing the organic component of bladder outlet obstruction. α-blockers, on the contrary, have a rapid effect and act on the dynamic component of obstruction. Thus, these drugs complement each other perfectly and, importantly, are pharmacologically compatible. With good compliance, long-term therapy with a combination of 5-α-reductase inhibitors and α-blockers avoids the need for surgical intervention, and therefore the associated disability for a certain period and the risk of complications.

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Therapist, Endocrinologist

Hello, this hormone is usually often ignored when examining for hyperadrogenism, because the norms that are indicated in laboratory forms are precisely for this purpose, the tests are very arbitrary and it is still unclear what the norms should be for this hormone. So if you have no complaints... then just forget about it, if you have complaints about hyperadrogenism (increased hair growth in the backend area, midline of the abdomen in intimate areas, or vice versa, hair loss on the head), then write about your complaints and write the results of all your examinations for hormones (with the standards of your laboratories) .... if the clinical picture is pronounced and the levels of hormones are very high, then you can look for a tumor.... but as a rule, the whole reason is PCOS or its combination with a disruption of the functioning of adrenal enzymes - there are tests for these disorders, but to know which enzyme to check you need to see the hormones

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Rustem, Hello. Thank you for your reply. There are just complaints - thinning and thinning of hair on the head and increased growth on the body. Using computed tomography, no tumors were found either in the pituitary gland or in the adrenal glands. There is no tumor and no ovaries - multifollicularity and absence of ovulation are established. At the time of visiting the local endocrinologist, the hormones tested were LH, FSH, Estradiol, Testosterone, Prolactin, 17-OH-Progesterone, DHEA-SO4, Cortisol, Progesterone, thyroid hormones - TSH and free T4, Androstenedione, as well as the insulin resistance index. The excess was in Prolactin 557, the upper limit is 714, my result is insignificant, in Testosterone it is insignificant - the norm is 0.52-1.72, I have 1.73 nmol/l, in DHT the norm is 24-450, I have 878. The endocrinologist prescribed Diane- 35, but my hair was still falling out, I took DHT again, and even when taking Diane-35 it was also increased by 2 times. That is, such therapy with COCs does not even completely mask the disorders. Now I’m still on COCs, because without them the external changes are even worse and I have terrible pain during my not particularly regular periods. Tell me in what direction to be examined further, so that I can then contact you with the results and draw some conclusions?

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Rustem, problems with the cycle since the age of 12. But then the doctor said that “there is a teenage “settling down” of hormones, take your vitamins, come back later if you have problems.” There were problems - periods were 3-10 days behind, painful to the point of nausea. Janine was appointed. My weight is 51 kg with a height of 170, it has not grown or decreased as with oncology. Weight has been stable since the age of 12 +- 1-2 kg. But my hair thins starting at age 20. About two or three years ago, the apotheosis of the loss came. All this time, Diana-35 was already prescribed. The cycle is now smooth, but the DHT is still high and the hair is growing and thinning. And the most important thing is that the diagnosis has not yet been established. As I understand it, you need to interrupt the COC for a month and take hormones to understand what you have come to. LH, FSH, Prolactin, Free testosterone, DHT, 17-OH progesterone, DHEA-s and ultrasound - maybe something extra or, on the contrary, is something else needed to clarify the diagnosis, if after the test I contact you for a fee?

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