Peter Attia is cautious about prescribing 5-alpha reductase inhibitors due to limited efficacy, potential side effects, and the need for active monitoring.

“so I I just I I ABS I think finasteride is a very bad drug and I think it has very detrimental effects”

“yeah I mean I don't recommend it in for use in any any any man if it's one or otherwise yeah”

“so I'm very cautious about doing that so for me I reach for an alpha blocker if the alpha blocker is working in terms of improving the kind of outlet obstruction symptoms that's strength of the stream how fast can you empty but patients still have a a significant um urinary bother increased urinary frequency urgency to go to the bathroom then you can either do a a antimuscarinic or an M3 Agonist which is the newest class in that kind of category which really helps relax the muscles in the bladder and really significantly impact the um symptomatology for people with those kind of predominantly what we would call Storage symptoms you can have obstructive symptoms alpha blockers are great for those you can have storage symptoms and and storage symptoms are frequency frequency urgency just think about it if you have a thick bladder is impeded the compliance is poor it doesn't stretch well it's hard it's just always kind of um feels full then those are things that can be very nicely address with these agents the antimuscarinics are dangerous or you need to be careful when using those because in aging individuals they can they are associated with worsening of dementia and other kinds of neurologic cognitive wow you know Acuity so the M3 agonists which is is has the same net effect are much cleaner so let's much less side effects and so and the antimuscarinics were just older drugs they were and it was the first line so the the the so we kind of put those in the same categories maybe the five Alpha reductase Inhibitors which is it's you you always look for a better option first”

“uh yeah I don't I again I I don't like to be in the business of prescribing things for which I don't have a great understanding which is why I'm not in the business of treating hair loss.”

“So I feel pretty strongly that if you're presenting with BPH, you should not be on a five alpha reductase inhibitor. It's simply unnecessary.”

“I would encourage them if they've never taken it before not to because I think there are enough other compounds, oral minoxidil, topical minoxidil, topical five alpha reductase inhibitors, PRP transplants. I think there are enough other tools that you can do to avoid the small but not necessarily zero risk of something going wrong in terms of sexual side effects that in the worst case might not be reversible.”