Finasteride treatment of hypersexuality associated with vascular dementia and underlying benign prostate hyperplasia
Background: It is known that there is a considerable change in sexual activity following stroke and dementia. Hypersexuality has no proven treatment, although reports have described reductions in hypersexual behavior using anti-psychotics or serotonergics. However, patients, whose sexual behavior did not respond to these medications, were intermittently observed in clinical practice. The purpose of this study is to describe the clinical effects of finasteride not only in BPH, but also in hypersexualism secondary to vascular dementia. Methods: Participants included 10 men(mean age: 76.40±3.64, range:73-82) with their problematic sexually related behaviors who were diagnosed as vascular dementia according to NINDS-AIREN criteria, who had already had lower urinary tract symptoms secondary to benign prostatic hyperplasia. Their sexual behaviors included cuddling, touching of the genitals, sexual remarks propositioning, grabbing and groping, use of obscene language and masturbating without shame. In all instances concern emanated from members of the nursing staff. The diagnosis of BPH was established standard urologic evaluation with the International Prostate Symptom Score (IPSS), quality of life (QoL) index, peak urinary flow rate (Qmax), ultrasound measurement of prostate volume, residual urine volume, assay of prostate specific antigen(PSA), and digital rectal examination. ultrasound measurement of prostate volume, assay of prostate specific antigen(PSA). From the studies, all of them were started on finasteride 5 mg once daily without any other medication which could influence on their abnormal behaviors except antidementia medications. Results: A few months after taking finasteride, all of the enrolled patients showed improvement of voiding symptoms and half of them showed amelioration of hypersexuality and no unwanted side effects. Conclusions: This study demonstrates that finasteride as an anti-androgenic effect decreased libido and hypersexual behavior without serious side effects in patients with vascular dementia and underlying BPH. Further studies that obviously define the response and long-term side effects of finasteride are needed to confirm our observations.