Letter to the Editor
Phosphodiesterase inhibitors used in androgenic alopecia as a possible risk factor for testicular tumor
Inhibidores de la fosfodiesterasa en la alopecia alogénica como posible factor de riesgo de tumor testicular
María Sainz Ramírez
, Rubén García Robles, Oliver Luis Salguero Molpeceres
Corresponding author
Centro de Salud Cerro del Aire Majadahonda, Madrid, Spain
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Its prevalence increases with age, and is an ever-increasing cause of concern, especially for men. That is why the pharmaceutical industry is developing drugs to combat it, most of which are based on inhibiting 5-phosphodiesterase.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">These drugs include finasteride, whose dosage in the case of alopecia is generally 1 mg/day. Regarding this medicinal product, problems with reproduction associated with its use have already been described.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The reason for this letter is to comment on two clinical cases seen in our Primary Care consultancy. The cases involve two young men (25 and 29 years old) who came to the consultancy prompted by the appearance of a testicular lump while undergoing treatment with this drug for alopecia. They had been in treatment for four and six years, respectively. Our medical team were unaware of the treatment, in part, because it was a non-funded medicinal product. In both cases the ultrasound showed the presence of a testicle-dependent heterogeneous mass, and they were referred to Urology. Both were diagnosed with a germ cell tumor (seminoma and mixed tumor, respectively). Both underwent surgery, received subsequent chemotherapy and currently have no signs of relapse.</p><p id="par0020" class="elsevierStylePara elsevierViewall">After receiving the definitive pathology results, we reported both cases to the Spanish Medicines Agency (EMA) through the web notification system, under the suspicion of being finasteride-treatment related. We have not received a response in this regard.</p><p id="par0025" class="elsevierStylePara elsevierViewall">When examining the available bibliographical sources (search carried out in academic Google, search years 1996–2022, with the terms “Finasteride AND Seminoma”), we found several cases of testicular tumors in patients receiving finasteride treatment. One of them was a seminoma in a transgender woman,<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> although in this case the dose was 5 mg and not 1 mg as in the two cases in our practice. Another was a Leydig cell tumor<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> and, the third, a Leydig cell hyperplasia resembling a malignant tumor,<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> with both patients taking 1 mg of finasteride daily.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Following the Naranjo algorithm, we obtain a score of 2 points, which, together with the available bibliography and the findings of our patients, suggests a possible connection between taking finasteride and the appearance of testicular tumors.</p><p id="par0035" class="elsevierStylePara elsevierViewall">These are two cases that have coincided in our consultation. We are concerned that patients continue these treatments without monitoring by their primary care physician. We are also concerned that taking this medication could be a risk factor for developing testicular germ cell tumors in certain patients.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0040" class="elsevierStylePara elsevierViewall">This study has not received funding from any source.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Ethical considerations</span><p id="par0045" class="elsevierStylePara elsevierViewall">The ethics in our centre regarding patient data protection have been followed.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflict of interests</span><p id="par0050" class="elsevierStylePara elsevierViewall">We declare that there is no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Ethical considerations" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflict of interests" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tratamiento de la alopecia androgenética" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J. 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