Changes in HDL-cholesterol and lipoprotein Lp(a) after 6-month treatment with finasteride in males affected by benign prostatic hyperplasia (BPH)

Androgen effects on lipoproteins, mainly high density lipoprotein (HDL), co uld be exerted by a direct interaction of testosterone (T) or dihydrotestos terone (DHT) with liver androgen receptors. To assess if T needs to be conv erted into DHT to affect lipid metabolism, 13 patients were studied, affect ed with benign prostatic hyperplasia (BPH) and treated with an inhibitor of 5 alpha-reductase (finasteride). They were compared with 15 untreated cont rols. At baseline and after 3 and 6 months of therapy, each patient was eva luated as for lipoprotein and hormone concentrations, as well as for nutrit ional status. Body composition was assessed by anthropometry and bio-impeda nce analysis (BIA). Treatment was associated with a significant increase of HDL-cholesterol (HDL-C), mainly HDL3 subclass, and lipoprotein(a) (Lp(a)), as well as a decline of DHT, whereas no significant changes were apparent for T, estradiol (E2), sex hormone binding hormone (SHBG) and body composit ion indexes. However, no significant associations between DHT and lipid rel ative changes were apparent at bivariate correlation analysis. This finding was confirmed by comparing patient subsets identified by cluster analysis, according to HDL subclass individual responses. Rather, a slight associati on with E2 for HDL2 (positive) and HDL3 (negative) was found. In conclusion , finasteride can modify HDL and Lp(a) concentrations. However, by the data , these effects cannot be definitively attributed to the changes in DHT syn thesis induced by finasteride, since a direct and non-specific interference of the drug on liver metabolism cannot be excluded. (C) 2000 Elsevier Scie nce Ireland Ltd. All rights reserved.