Can Sodium-Glucose Linked Transporter 2 (SGLT-2) inhibitors cause prostate issues?

SGLT-2 Inhibitors and Prostate Issues

SGLT-2 inhibitors do not cause prostate issues, but they can cause genital mycotic infections including balanitis in men, which may be mistaken for prostate problems. 1

Genital Infections: The Main Concern for Men

SGLT-2 inhibitors are associated with an increased risk of genital mycotic infections, which is the most common adverse effect in both men and women:

• Men specifically can develop balanitis (inflammation of the glans penis) 1, 2
• These infections are typically not serious and usually respond well to standard antifungal treatment 1, 2
• The risk is significantly higher compared to other diabetes medications, with a 2.47-fold increased risk within 30 days of starting treatment 3
• Meta-analyses show approximately a 3.4-3.9 times higher risk of genital infections compared to placebo or active comparators 4

Urinary Tract Infections: Not Significantly Increased

Despite early concerns, large clinical trials have not shown a significant increase in urinary tract infections with SGLT-2 inhibitors:

• The American College of Cardiology guidelines note that large clinical trials have shown no difference in rates of urinary tract infections between SGLT-2 inhibitors and placebo 1
• The only exception is dapagliflozin 10mg daily, which has been associated with a slightly increased risk of UTIs compared to placebo (RR 1.33) 4
• The overall adjusted hazard ratio for UTIs is 0.89 (95% CI, 0.78-1.00) 3

Prostate-Specific Considerations

There is no evidence in the medical literature linking SGLT-2 inhibitors to:

• Prostate enlargement (BPH)
• Prostatitis
• Prostate cancer
• Changes in prostate-specific antigen (PSA) levels

Management Recommendations for Male Patients

If prescribing SGLT-2 inhibitors to male patients concerned about genital issues:

1. Provide education on proper genital hygiene to reduce the risk of infections 2
2. Inform patients about symptoms of genital mycotic infections (redness, itching, discomfort of the glans penis) 1, 2
3. Reassure patients that these infections typically resolve with standard antifungal treatment and rarely recur 1
4. Monitor patients with recurrent genital infections as they may need to discontinue the medication if infections become burdensome 1

Other Safety Considerations with SGLT-2 Inhibitors

While not related to prostate issues, patients should be aware of other potential side effects:

• Volume depletion (particularly in elderly patients or those on diuretics) 1
• Risk of euglycemic diabetic ketoacidosis (rare but serious) 1
• Potential increased risk of lower limb amputations (primarily with canagliflozin) 1
• Possible increased risk of bone fractures in older adults 1, 2

Conclusion

The evidence clearly shows that SGLT-2 inhibitors do not cause prostate-specific issues. The genital concerns with these medications are primarily related to fungal infections, which are manageable and rarely serious. The benefits of SGLT-2 inhibitors in reducing cardiovascular events, heart failure hospitalizations, and progression of kidney disease typically outweigh these risks for most patients.