Finasteride and Male Fertility: What You Should Know

Key Takeaways:

• Cases of finasteride affecting male fertility are rare but not unheard of.

• Using oral finasteride shouldn’t affect your partner’s ability to conceive and have a healthy pregnancy.

• Discontinuing finasteride temporarily should offset any effects the medication might have on sperm production and semen volume.

• Ask your healthcare provider if you’re concerned about finasteride and male fertility issues.
  

You’ve probably heard of finasteride as a go-to fix for thinning hair and hair loss. But what many guys don’t hear is how the little pill that boosts hair growth may affect something even more important: their ability to have kids.

The possible connection between finasteride and male fertility isn’t totally straightforward. Still, knowing the facts can help you make informed decisions about your hair health and your family plans.

Finasteride is the gold standard in treating hair loss, but like many powerful 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 your finasteride fertility questions.

Finasteride is the main ingredient in Propecia^® and Proscar^®. It was originally approved by the Food and Drug Administration (FDA) in 1992 for treating benign prostate hyperplasia (BPH), also known as an enlarged prostate.

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 (mg) daily dose vs. 5 mg for BPH.

Both male pattern baldness and BPH are common conditions. Research shows that each condition affects as many as 50 percent of men by age 50. 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 (5AR) inhibitor. As the name suggests, it inhibits (or slows) an enzyme called 5α-reductase that converts testosterone into dihydrotestosterone (DHT).

Your body naturally churns out DHT as a byproduct of testosterone. Though DHT plays a crucial role in healthy development during the fetal and puberty stages, it can be much less helpful later on.

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

How Finasteride Affects DHT

Finasteride helps slow testosterone’s conversion to DHT. This lowers DHT levels, which helps you hold onto your hair, even if your genetics are trying to get in the way.

In people with BPH, finasteride can often 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.

When 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 show that the average age of a father in the U.S. at the time of their child’s birth is 30.9. Just under 9 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) or 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 evaluated 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 a little more than 1 mg) can reduce sperm counts in some men — and sperm count is a significant factor in male infertility.

The better news? Discontinuing the drug led to “substantial” improvements in sperm count.

Research on Finasteride and Sperm Cell Production

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

A 2004 study also noted that finasteride didn’t appear to affect sperm cell production. However, the research suggested that having a separate or unrelated fertility issue might amplify any negative impacts of finasteride on male fertility.

Another quick note: It would make sense to think lower semen volume (or 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.

For some guys, finasteride can affect sex drive, lowering their 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.

→ Learn more: The Hims Guide to Libido and Sex Drive

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.

The FDA notes that sexual dysfunction side effects — including lowered sex drive and lower ejaculate volume — are uncommon, occurring in less than 2 percent of men who take finasteride. And the adverse effects disappear with time — both in men who discontinue the drug and many who stay on it.

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

One positive side effect of finasteride for hair restoration is the confidence that can come with a fuller, thicker head of hair. Greater confidence can lead to better bedroom performance, which can, in turn, lead to fatherhood. (Maybe a stretch, but you get what we’re saying.)

→ Read: Does Finasteride Cause Erectile Dysfunction (ED)?

Finasteride isn’t FDA-approved for 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 when having sex with their pregnant partner, particularly when the fetus is developing genitals around 8 to 10 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 healthy babies without birth defects.

If you’re not trying to conceive, don’t make the mistake of thinking finasteride is some sort of magical male birth control. Best to stick with the proven options.

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

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

The risks of finasteride-fertility problems are low. Still, 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 6 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 in men.

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

When he stopped taking the medication, his sperm concentration increased dramatically in 6 months. This was also true of a 32-year-old with very low sperm count (severe oligospermia).

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 medical 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. Here are your options.

Topical Minoxidil

Minoxidil (Rogaine^®) is FDA-approved as a topical solution for androgenetic alopecia. It differs from finasteride in that it doesn’t block DHT.

Instead, minoxidil is a vasodilator, meaning it delivers more blood and oxygen to the scalp and hair follicles. It stimulates hair growth by extending the anagen phase of the hair growth cycle, so hair stays in the growth window for longer.

This ingredient is found topically in our minoxidil foam and minoxidil liquid solution (both at 5% strength).

Oral Minoxidil

You can also get an oral version with our minoxidil chewables. (As a compounded product, this form of minoxidil isn’t FDA-approved, so the FDA doesn’t guarantee its safety or effectiveness.)

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 generally considered safe and effective.

Minoxidil and finasteride are also complementary, meaning they’re safe and more effective when used 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.

→ Related: The Best Natural Hair Growth Remedies

Considering finasteride for hair loss or BPH, but worried about its effects on sperm? Here’s the bottom line on finasteride and male fertility:

• Finasteride may affect fertility. This is rare. But since it directly affects 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, but morphology and motility aren’t known to be affected.

• It’s reversible. Finasteride discontinuation leads to improvements in sperm DNA and sperm count, with noticeable recovery within 6 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.

→ Read next: Is Your Screen Time Tanking Your Sperm Count?

See answers to frequently asked questions about finasteride and male fertility.

Does finasteride affect male fertility?

Studies suggest that finasteride might affect fertility in some cases, but this is rare. However, many guys who use finasteride become dads. If you’re concerned, talk with your healthcare provider.

Are finasteride fertility problems permanent?

Finasteride fertility problems generally aren’t permanent. If any problems with sperm count and semen volume are diagnosed, discontinuing finasteride is often enough to make those problems go away within 6 months.

Does finasteride dosage make a difference with side effects?

Possibly. Taking the 1-mg finasteride pill for hair loss is associated with far fewer side effects (including any fertility issues) than the 5-mg dose prescribed for benign prostate hyperplasia.

If I use finasteride, could it affect my partner’s ability to conceive?

There is no convincing evidence that a man’s use of finasteride will affect his partner’s ability to become pregnant and deliver a healthy baby.

→ Read next: Can a Man Recover From Low Sperm Count?

This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment. Learn more about our editorial standards.