Finasteride is one of just two approved treatments in the UK for tackling male pattern baldness. As a result, it’s used by thousands of men everyday to stave off baldness and maintain their hair.
Finasteride results for a 57-year-old patient before and after 9 months of use.
But some recent studies have shown that Finasteride may impact fertility in men. This can be a cause for concern for those who are thinking about starting a family in the future.
So how exactly does Finasteride affect fertility, and how strong is the evidence that you should stop taking Finasteride if you’re trying for a baby? Here, we take a look at the science to discover the real link between Finasteride and fertility.
Some studies have shown that Finasteride can have an impact on male fertility [1-4]. Even at low doses (such as the daily 1mg dose usually prescribed to treat androgenetic alopecia), Finasteride may reduce sperm count in some men [1].
However, the NHS notes that Finasteride-related infertility is uncommon [5]. Not only that but stopping Finasteride will usually reverse any sperm or fertility issues it causes within a few months.
While Finasteride doesn’t necessarily cause fertility problems in all users, its fertility-damaging effects may be amplified in men who are already prone to fertility issues [2]. So if you know you have low sperm count or reduced sperm motility, Finasteride may make these problems worse.
You won’t usually know whether you have fertility problems until you start trying to conceive. But there are other important reasons to carefully consider your Finasteride usage when trying for a baby.
Even if Finasteride doesn’t affect your fertility, it can affect your partner’s pregnancy if you do conceive. Finasteride can pass into semen and potentially cause problems for your baby’s development.
Some evidence shows Finasteride may impact the physical development of a male foetus [6-7]. Women are advised to avoid taking Finasteride (or even touching crushed or broken Finasteride tablets) for this reason.
Not all researchers agree that there’s a high risk of birth defects from Finasteride in the sperm [7-8]. However, NHS guidance states that men who are trying for a baby or who have a pregnant partner avoid taking Finasteride until after the baby is born.
Find out more about Finasteride and pregnancy.
Few studies have investigated the link between Finasteride use and female fertility, possibly because Finasteride is rarely prescribed to women with hair loss.
One study found that Finasteride didn’t cause any changes in follicular development (the process of an egg maturing in preparation for release during ovulation) [9].
However, women should always use effective contraception to prevent pregnancy if they are using Finasteride. That’s because of the impact Finasteride can have on foetal development.
Topical Finasteride is an alternative hair loss treatment that’s not currently licensed for use in the UK. However, it can be prescribed off-label in some cases. Studies have shown that it can effectively treat hair loss, and may cause fewer systemic side effects than oral Finasteride [10].
In one literature review, researchers found no instances of decreased sexual desire, performance, or sperm count among patients using topical Finasteride [10]. So this may be a safer option for men who are thinking about conceiving.
However, it’s important to speak to your hair treatment consultant if you’re thinking about using topical Finasteride. This is an unlicensed medicine, so you need to understand and weigh up the risks carefully.
Yes. Even if you’ve been taking Finasteride for several years, it’s still possible to conceive without fertility treatments [2]. It depends on the impact Finasteride has on your sperm health.
There has been at least one case report of a healthy baby being delivered after the male partner’s long-term Finasteride use [2]. However, in this case, the man stopped taking Finasteride to boost his sperm count. After an initial primary infertility diagnosis, the couple conceived within five months of the male partner stopping Finasteride use.
So even if you’re worried about infertility following Finasteride use, this effect may be temporary. Stopping Finasteride can restore healthy sperm and increase your chances of conception.
Studies showing improvements in fertility after stopping Finasteride use can help you understand the potential impact of taking Finasteride.
One study found that stopping Finasteride led to an 11.6-fold increase in sperm count [1].
Another found that the sperm DNA fragmentation index (DFI) — a score that shows the extent of sperm damage, with higher scores indicating higher levels of damage — was as high as 30% in Finasteride users [3]. Three months after stopping Finasteride, sperm DFI had reduced to 21%. After another three months, it had dropped further to 16.5%.
This suggests Finasteride can have a significant effect on sperm health. The good news is that sperm usually revert to good health after a few Finasteride-free months.
Low sperm count is known as oligospermia. One study found that 57% of men with severe oligospermia (that is, fewer than five million sperm per millilitre of semen) saw their sperm count increase to more than 15 million/ml after stopping Finasteride [1]. This suggests Finasteride may decrease sperm count by up to a third.
Two other cases of patients with reduced or zero sperm counts had significant improvements six months after stopping Finasteride [4].
Yes, it’s usually recommended that men stop taking oral Finasteride before trying to conceive. Not only is it possible that stopping Finasteride will give your sperm health a boost in preparation for conception, but it’s also safer if your partner does fall pregnant.
Unfortunately, your hair loss is likely to resume when you stop taking Finasteride. But switching to another hair loss treatment may lower the risk to your fertility and your baby, while still maintaining your hair.
Alternatives to Finasteride include:
If you’re unsure of the impact of hair loss treatments on your fertility, it’s a good idea to discuss your concerns with a hair loss specialist and your GP. At the Wimpole Clinic, we can help you find a low-risk treatment plan that helps maintain your hair without risking your fertility.
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