Introduction: Finasteride and dutasteride are competitive inhibitors of 5-alpha reductase (5AR) enzymes and are commonly used for the treatment of symptomatic benign prostatic hyperplasia (BPH). This study is intended to evaluate the literature regarding the relative efficacy of these two agents on clinically important outcomes. Method: Randomized control trials, quasi-randomized trials, and systematic reviews comparing finasteride to dutasteride either as monotherapy or in combination with alpha-blockers in men with BPH were included. The outcomes studied included need for prostate-related surgery, acute urinary retention episodes, withdrawal due to adverse events, total serious adverse events, mortality, and sexual dysfunction. Results: There were no differences in need for prostate-related surgery (OR 2.01, 95% CI: 0.18, 22.24), acute urinary retention episodes (OR 1.47, 95% CI: 0.68, 3.19), number of withdrawals due to adverse events (OR 1.10, 95% CI: 0.68, 1.75) or serious adverse events (1.31, 95% CI: 0.87, 1.97). The odds ratios for sexual dysfunction and total adverse events were 0.83 (95% CI: 0.64, 1.08) and 0.94 (95% CI: 0.78, 1.14) respectively. Conclusion: There is insufficient evidence to suggest clinically important differences between finasteride and dutasteride at this time.