Can dutasteride (5-alpha-reductase inhibitor) cause hearing issues?

Dutasteride and Hearing Issues

Based on the available evidence, dutasteride (a 5-alpha-reductase inhibitor) has not been associated with hearing issues or ototoxicity in clinical guidelines or research studies.

Known Side Effects of Dutasteride

Dutasteride is a dual inhibitor of both type 1 and type 2 isoforms of 5-alpha-reductase, which is more potent than finasteride in reducing dihydrotestosterone (DHT) levels. The well-documented adverse effects include:

• Sexual dysfunction:

  • Erectile dysfunction (2-4% higher than placebo) 1
  • Decreased libido (reported in multiple studies) 1, 2
  • Ejaculation disorders including decreased ejaculate volume 1

• Endocrine effects:

  • Gynecomastia (breast enlargement in men) 1, 2

• Other documented concerns:

  • Potential increased risk of high-grade prostate cancer (Gleason score 8-10) 2
  • Metabolic alterations during long-term treatment 2

Absence of Hearing-Related Side Effects

The comprehensive guidelines from the American Society of Clinical Oncology/American Urological Association make no mention of hearing loss or ototoxicity associated with dutasteride or other 5-alpha-reductase inhibitors 1. These guidelines provide detailed listings of adverse effects, and hearing issues are not among them.

Drugs Known to Cause Hearing Loss

According to research on drug-induced hearing loss, the medications known to cause ototoxicity include 3:

• Aminoglycoside antibiotics
• Cancer drugs (particularly cisplatin)
• Loop diuretics (such as furosemide)
• Phosphodiesterase-5 inhibitors (such as tadalafil)

Dutasteride and other 5-alpha-reductase inhibitors are not included in this list of ototoxic medications.

Clinical Implications

When prescribing dutasteride, clinicians should:

1. Focus on monitoring and counseling patients about the well-established side effects:

   • Sexual dysfunction (which may decrease over time but remains statistically significant) 1, 2
   • Gynecomastia
   • Effects on PSA levels (approximately 50% reduction after 12 months) 2

2. Consider the overall discontinuation rate due to adverse events is approximately 6-7%, similar to placebo 2

3. Be aware that the American Urological Association recommends discussing potential sexual side effects and their possible persistence before initiating therapy 2

Conclusion

While dutasteride has several well-documented side effects that should be monitored, there is no evidence in the current literature to suggest that it causes hearing issues or ototoxicity. Patients concerned about hearing problems while taking dutasteride should be evaluated for other potential causes of hearing loss, including age-related changes, other medications, or underlying medical conditions.