Meet the Expert: Medically reviewed by Dr. Darren Bryk, AKA the sperm whisperer, a urologist at the University of Virginia Urology Center. Dr. Bryk has a special interest in male factor infertility and men’s health.
Male pattern baldness is, unfortunately, pretty darn common, which is why brands like Rogaine are a household name. An entire cottage industry has sprung up to help men fight off hair loss, and there’s no shortage of online companies shipping discreet packages of key medications, such as finasteride, right to their doors. While it’s true that finasteride works minor miracles on that receding hairline and back-of-the-head bald patch, it’s also true that it can come with side effects—some of them sexual. So, what does that mean in terms of male fertility? Here’s what couples should understand about the effects of popular hair-loss medications on sperm health.
- Finasteride is one of several medications used to combat hair loss.
- The oral form of finasteride is associated with side effects, including detrimental effects to sperm health.
- Studies show that finasteride is associated with depression, a variety of sexual side effects and reduced sperm count.
When it comes to problematic sexual side effects in the world of hair-loss medications, finasteride reigns supreme. It’s one of a handful of drugs used in the war against hair loss, and it’s quite effective in low doses—but it may come at a cost (1). This prescription medication comes in oral and topical form, and it’s the tablet that’s most associated with problems. Best known under the brand name Propecia, finasteride is a double-whammy drug that both stimulates hair growth and reduces hair loss, with efficacy that improves over time. As with all hair-loss medications, you need to keep using it to see and maintain results. A big majority of men who use finasteride report improvement in their hair, so it’s generally well regarded in that respect.
Finasteride works by blocking the conversion of testosterone to dihydrotestosterone, or DHT (2). This potent hormone is key for sex differentiation, but it’s also associated with hair loss because it shrinks hair follicles and shortens the hair growth cycle. Men with male-pattern baldness generally have higher levels of DHT and smaller hair follicles. By keeping DHT concentrations low, finasteride can help slow hair loss and promote regrowth.
Now for the bad news.
Finasteride and Male Fertility
In addition to blocking the DHT conversion, finasteride also interferes with another hormone—prostaglandin. This hormone is normally present in semen and supports a number of key sperm functions, including motility and capacitation, which is a key step for fertilization. So, what does that mean for sperm health and male fertility as a whole? Let’s look at the data:
- According to one 2020 study, men who began taking finasteride for hair loss had lower sperm count within six months (3).
- Researchers who conducted an older study on finasteride use in the male infertility population determined that even at low doses, as it’s used for hair loss, finasteride is associated with reduced sperm counts (4). The study’s authors concluded, “Finasteride should be discontinued in subfertile men with oligospermia, and used with caution in men who desire fertility.”
There’s also mixed data (5) that suggests additional possible sexual side effects of oral finasteride include:
- Erection issues
- Low libido
- Pain in the testicles
A big question is whether finasteride’s effects on male fertility are permanent, and again, research is mixed. Some studies show improvement in sperm count after men discontinue the medication, while others continue to report ongoing sexual side effects well after a year. In fact, the condition is common enough to have earned its own name: post-finasteride syndrome, or PFS (6).
So… What Now?
Couples who are planning on becoming parents are advised to clean up their lifestyle, which includes being very mindful of anything that goes in or on their bodies. The safest course of action for men who are currently using oral finasteride is to stop. But if warding off that bald spot is a sticking point, speak to your doctor about minoxidil instead. This FDA-approved medication is also used to combat hair loss, and it’s less associated with sexual side effects.
Of course, men and women alike should both be taking prenatal vitamins to shore up nutritional gaps in their diets. Subpar sperm health is very often the result of nutrient deficiencies (7), and there is data that finds vitamins and minerals play an important though unclear role in normal hair follicle development (8). Specifically, one study calls out biotin, folate, riboflavin and vitamin B12 deficiencies as associated with hair loss. A good men’s prenatal vitamin, like our own Beli Vitality for Men™, can help ensure you’re checking at least some of those off the list, while also delivering a steady stream of key nutrients shown to promote and support sperm health.
The Bottom Line
The big takeaway when it comes to hair-loss medications, specifically finasteride, and male fertility is that it’s entirely possible the former is actively impeding the latter. In other words, we don’t know for sure, but there’s enough evidence that it’s best to err on the side of caution. If you’re committed to doing everything within your power to boost your chances of a successful conception, pregnancy and baby, steering clear of finasteride is probably wise.
- Finasteride. National Library of Medicine. (2022). https://medlineplus.gov/druginfo/meds/a698016.html
- Zito, P et al. (2022). Finasteride. https://www.ncbi.nlm.nih.gov/books/NBK513329/
- Palloti, F et al. (2020). Androgenetic alopecia: effects of oral finasteride on hormone profile, reproduction and sexual function. https://pubmed.ncbi.nlm.nih.gov/32052367/
- Samplaski, M et al. (2013). Finasteride use in the male infertility population: effects on semen and hormone paramters. https://pubmed.ncbi.nlm.nih.gov/24012200/
- Mysore, V. (2012). Finasteride and sexual side effects. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3481923/
- Rezende, H et al. (2018). A comment on the post-finasteride syndrome. https://pubmed.ncbi.nlm.nih.gov/30783332/
- Skoracka, K et al. (2020). Diet and nutritional factors in male (in)fertility—underestimated factors. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7291266/
- Almohanna, H et al. (2019). The role of vitamins and minerals in hair loss: a review. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6380979/#:~:text=Only%20riboflavin%2C%20biotin%2C%20folate%2C,(FAD)%20%5B22%5D.