Finasteride and Male Fertility: What You Should Know

When you’re thinking about starting a family (or adding to it), you start to consider things that never mattered before. Has your laptop been on your lap too long? Should you skip that third beer? And if you’re taking hair loss medication, you might wonder if there’s a link between finasteride and fertility or sperm count.

Finasteride is the gold standard in treating hair loss, but like most medications, it has some potential side effects. Although rare, this prescription drug may have a temporary impact on male fertility.

Read on for answers to all your finasteride fertility questions.

Finasteride is the active ingredient in Propecia® and Proscar®. It was originally approved by the FDA (U.S. Food & Drug Administration) in 1992 for treating benign prostate hyperplasia (BPH), a non-cancerous prostate enlargement.

Later, in 1997, it was approved to treat male pattern baldness (also called androgenetic alopecia or androgenic alopecia). This use calls for a lower 1-milligram daily dose versus 5 milligrams for BPH.

Both of these conditions are common. Research shows that pattern baldness and BPH each affect as many as 50 percent of men by age 50 — and finasteride is widely used by adult men of all ages.

If you’ve been taking it for a while, you might already have the scoop on how finasteride works. But to make sure everyone’s on the same page, here’s a quick refresh.

Oral finasteride is a 5-alpha-reductase inhibitor. As the name suggests, it inhibits (or slows) an enzyme called 5α-reductase that converts testosterone to dihydrotestosterone (DHT).

Your body naturally churns out DHT as a byproduct of testosterone. Though DHT plays a crucial role in development during the fetal and puberty stages, it can stir up trouble as the years roll on.

All men have some degree of DHT (it just comes with having testosterone). But for those genetically sensitive to its effects, DHT can shorten the growth (anagen) phase of the hair growth cycle and shrink hair follicles, ultimately leading to hair loss.

Enter: finasteride. The medication helps slow testosterone’s conversion to DHT. This lowers DHT levels, which helps you hold onto your hair, even when you haven’t won the genetic lottery.

In people with BPH, finasteride can stop the prostate from growing larger and eventually shrink it.

Like all medications, finasteride isn’t without potential adverse effects, and many wonder about the link between finasteride and fertility for men.

As younger men of reproductive age began taking finasteride for hair loss (BPH rarely causes symptoms before age 40), there started to be more buzz about its effects on fertility.

This isn’t to say men over 40 don’t have children. But 2015 data shows that the average age of a father in the U.S. at the time of their child’s birth is 30.9. And just under nine percent of infants have a father over 40.

Finasteride for hair loss continues to grow in popularity, so there are more men taking it who want to have children, either soon or someday.

How Often Does Finasteride Affect Fertility?

Maybe you’re among the men wondering, Can finasteride affect fertility? The quick answer is yes, finasteride can affect fertility — but it’s not common.

Fertility issues from taking finasteride aren’t permanent, either. Fertility will typically return to baseline within a few months after stopping the drug — we’ll get into more detail about this below.

Studies show that finasteride can reduce several semen parameters, including semen volume and sperm count. But again, these effects are usually reversible once you stop taking the drug.

Research also shows that finasteride doesn’t compromise sperm motility (how fast the little guys move) and sperm morphology (the shape, size, and appearance of sperm).

Research on Finasteride Sperm Count and Quality

Finasteride’s effect on fertility may be especially noticeable in men with a history of fertility issues. One study looked at men who went for evaluation at a fertility clinic between 2008 and 2012. Just 0.6 percent (27 out of 4,400) were on finasteride.

The researchers concluded that even a low dose of finasteride (the average dose in the study was just over 1 milligram) can reduce sperm counts in some men, which is a significant factor in male infertility. The better news? Discontinuing the drug led to “substantial” improvements in finasteride sperm count.

On the other hand, an older (but well-done) study from 1999 looked at 191 men between ages 19 and 41. It found that daily treatment with 1 milligram of finasteride for 48 weeks didn’t affect spermatogenesis (sperm cell production) or semen production in young men.

Another quick note: It would make sense to think lower semen volume (or finasteride watery semen, a known side effect of finasteride) means less chance of pregnancy, but that’s not the case. There’s no evidence of a link between the probability of pregnancy and ejaculate volume.

After all, it takes just one sperm.

Finasteride can affect your sex drive, lowering your libido. And if you don’t have sex because you’re not in the mood, it’s tough to get someone pregnant. Groundbreaking, right?

Another potential side effect is difficulty getting an erection, which can also make sex tricky. So while these factors don’t directly cause infertility, they can make it harder to conceive.

Sexual Side Effects of Finasteride Are Rare

If you’re reading this and wondering why anyone would take finasteride, it’s important to contextualize these side effects. While they can happen, finasteride side effects are very rare.

Information from the FDA notes that sexual dysfunction side effects — including lowered sex drive and lower ejaculate volume — are uncommon, occurring in less than two percent of men who take it. And the adverse effects disappear with time, both in men who discontinued the drug and many who stayed on it.

Plenty of men take finasteride and don’t experience any changes to libido or sexual function.

Finasteride isn’t FDA-approved in women because of the potential for birth defects (congenital abnormalities) in a male fetus.

Pregnant women are even advised not to handle crushed or broken finasteride tablets. So it makes sense to have concerns about taking finasteride or exposing a female partner to finasteride while trying to conceive.

The good news? There appears to be minimal risk to female partners of men taking finasteride. A review of data noted that “the transfer through semen is significantly lower than doses known to affect fetal development.”

Taking Finasteride When You Have a Pregnant Partner

Some worry about semen exposure (aka having sex with their pregnant partner) when the fetus is developing genitals around eight to ten weeks. This is also not a huge concern.

There are many known cases of men who took finasteride either before or during their partner’s pregnancy and went on to have babies without birth defects.

And if you’re not trying to get anyone pregnant, don’t make the mistake of thinking finasteride is some sort of magical male birth control (hopefully, that’ll exist in the not-too-far future).

Finasteride is definitely not a contraceptive. Again, infertility from finasteride is very rare, and you can very much still get someone pregnant while taking this hair loss treatment.

Are you Googling “how long does finasteride stay in your sperm?” We got you.

You might want to stop using finasteride if you’re trying to conceive, particularly if you’ve been on the medication for a long time.

Exactly how long before trying to conceive you should stop taking finasteride is a nuanced conversation best had with your healthcare provider. That said, most research shows sperm counts returning to baseline within six months of stopping.

It can be scary to wonder if finasteride causes permanent infertility, especially if you know you definitely want kids — or aren’t sure but don’t want to close the door on the option.

Rest assured, finasteride isn’t known to cause permanent infertility.

More research is needed on the long-term effects, but we have a handful of case studies and clinical research. In one case, a 34-year-old had azoospermia (no detectable sperm) related to long-term finasteride use.

When he stopped taking the medication, his sperm concentration increased dramatically in six months. This was also true of a 32-year-old with severe oligospermia (very low sperm count).

Overall, research shows an average 11.6-fold increase in sperm counts after discontinuing finasteride.

Maybe you’re worried about potential finasteride fertility side effects. Or perhaps your healthcare provider advised you to stop taking it while trying to conceive or becoming a sperm donor.

In any case, you can explore other hair loss medications or even a different form of finasteride, which we’ll touch on below.

Minoxidil

Minoxidil is the active ingredient and generic version of Rogaine®. It’s FDA-approved as a topical solution for androgenetic alopecia and is also available off-label in pill form. It differs from finasteride in that it doesn’t block DHT.

Instead, minoxidil is a vasodilator, meaning it brings blood and oxygen to the scalp and hair follicles. It also prolongs the anagen phase of the hair growth cycle, so hair stays in the growth window for a longer period.

This ingredient is found topically in our minoxidil foam and minoxidil liquid solution (both at 5% strength). You can also get an oral version with our minoxidil chewables.

Topical Finasteride and Minoxidil Combined

Finasteride is also available topically. This is an off-label use (meaning it’s not FDA-approved), but it’s safe and effective.

Minoxidil and finasteride are also complementary, meaning they work better together. They’re paired in our topical finasteride & minoxidil spray, an easy way to use the two ingredients at once.

Topical finasteride isn’t known to cause sexual side effects. Any mild side effects only show up on the application site, but these are rare too.

Saw Palmetto

Saw palmetto is worth exploring for those seeking a natural alternative to DHT. While research is limited, some studies suggest it may inhibit the effects of DHT.

Our thickening shampoo with saw palmetto is a great starting point and doesn’t require a prescription.

For more, see our guide to the best treatment options for thinning hair.

Considering finasteride for hair loss or BPH but worried about its effects on sperm? Here’s what you need to know about its potential impact on male fertility and what steps to take if you have concerns:

• Finasteride may affect fertility. This is rare. But because of its effects on male sex hormones, finasteride can impact male fertility, potentially making it more difficult to conceive. Some men may have reduced ejaculate volume or sperm concentration, whereas morphology and motility aren’t known to be affected.

• It’s reversible. Research shows that finasteride discontinuation leads to improvements in sperm DNA and sperm count, with noticeable recovery in cases of azoospermia and severe oligospermia within six months.

• A healthcare professional can help. If you’re concerned about the effects of finasteride on your fertility, it’s essential to discuss this with your healthcare provider. They can go over alternative treatments or necessary precautions tailored to your personal health and family-planning goals.

Want to learn more about male infertility? Check out our guides to the fertility drug Clomid® and the potential link between screen time and sperm count.