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5-Alpha Reductase Inhibitors (5-ARIs) (Examples: Finasteride, Dutasteride ) Action: Shrink the prostate over time by lowering DHT Onset: Slower 6 to 12 months Efficacy: Shrinks prostate by ~ 2025% Reduces risk of surgery or retention by ~50% (MTOPS trial) Side Effects: Decreased libido Erectile dysfunction Rare: breast tenderness or depression 3

These compounds represent a surgical approach to endocrinology

But the side effects that receive the least attention online are the ones that matter most to anyone considering it: significant lean muscle loss documented by DEXA scanning, dopamine suppression that can flatten mood and drive, and dosing decisions where the difference between 8 mg and 12 mg is roughly 1 percent more fat loss and approximately double the side effects

Efficacy, safety, and cost of Goeckerman therapy compared with biologics in the treatment of moderate to severe psoriasis

Inconsistent administration