In this article, we’ll answer some of the most common questions about finasteride and male fertility, including whether it’s safe to use if you’re planning to have a baby or if your partner is currently pregnant. Pattern hair loss doesn’t only affect older men. In fact, it can strike at any point after you hit puberty and the specific timing has a lot to do with genetics, especially if a male family member also has hair loss. This means that many men find themselves dealing with hair loss while they’re considering starting a family. If you’re currently grappling with this question, the most important thing to understand is that finasteride, although effective, does carry certain risks including the potential to cause developmental harm, or birth defects.
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Does finasteride lower sperm count?
Finasteride can potentially lower a man's sperm count, but it’s considered a rarer side effect. Finasteride has been associated with a range of sexual side effects and effects on the reproductive system, including most commonly, erectile dysfunction and lowered sex drive. Since finasteride works by lowering dihydrotestosterone (DHT) levels, it’s been speculated that by changing the ratio of testosterone to DHT in the body, that finasteride may affect spermatogenesis, or sperm production. Available clinical data suggests that changes in sperm production are reversible, meaning it typically returns to normal after stopping treatment.
There have been no reports to date by the FDA that finasteride negatively affects male fertility. The data that does exist is based on a small case studies and reports, and all of them report recovery of sperm counts within 3 months of stopping finasteride. The effect of finasteride on sperm production may be dose-dependent, meaning the higher the dose, the higher the likelihood of a negative impact. It was shown in one study that higher dose finasteride (5 mg) reduced semen parameters, but that this was reversible. Participants taking the lower 1 mg dose (the one approved to treat male pattern hair loss) didn’t affect sperm production in healthy men (Overstreet et al., 1999).
A large prospective study that ran from 2008-2012 and involved over 4000 men who were seen at a fertility clinic analyzed the effects of taking low-dose 1 mg finasteride for pattern hair loss. The average age of patients was 37 years, who took finasteride for approximately 57 months. Researchers noted that finasteride use seemed to have a negative effect on some men that recovered once treatment was stopped. The recovery effects were more significant in men who already had oligospermia, or low sperm counts. This study suggests that the effects of finasteride on sperm production may vary between individuals and that if patients have a known issue with sperm counts, that it may be best to stop or hold off on finasteride treatment while trying to conceive (Samplaski et al., 2013).
Can I take finasteride while my wife is pregnant?
Whether you should take finasteride if your partner is pregnant should be discussed with your prescribing doctor. The biggest concern with finasteride use during pregnancy has to do with the female parent’s exposure (through skin, etc.). Remember, finasteride works by lowering DHT levels, which is a key developmental hormone for a male fetus. If you do decide to continue finasteride, remember that it’s important to protect your partner from accidental exposure to oral or topical forms of finasteride.
If you're using topical finasteride and have been given clearance by your doctor to continue using it while your partner is pregnant, please remember that finasteride can be absorbed through the skin. You’ll need to be extra careful about reducing the risk of transferring finasteride to your partner, whether that’s through pillowcases or bedsheets. Every time you use topical finasteride, you should wash your hands immediately after application with soap and warm water.
If you’re taking oral finasteride, it’s important to remember that pregnant women shouldn’t touch or handle broken or crushed finasteride tablets because of the potential for skin absorption. If exposure does happen, ensure that hands are washed immediately and consider informing your doctor.
Depending on your situation, you may also decide to stop finasteride temporarily, at least until after the pregnancy and your partner is no longer breastfeeding. It’s the safest way to lower the possibility of exposure but may not be an option for everyone. That’s why it’s so important to talk to your doctor.
Can a man take finasteride while trying to conceive?
Whether you can take finasteride while trying to conceive is best discussed with your doctor. It’s not uncommon for doctors to recommend that male patients stop using finasteride for a period of time before trying to conceive. While the exact amount of time hasn’t been scientifically investigated, 30 days is the window that people planning to donate blood need to abide by. It’s enough time to help ensure that most of the drug is eliminated from the body, further lowering the risk of finasteride being present in semen.
During this “washout” period, using some form of barrier contraception such as condoms can help lower the risk of accidental pregnancy. The timing of when to stop finasteride or whether finasteride use can continue after pregnancy should be discussed with your doctor.
Finasteride and birth defects
Although there have been no reports of birth defects in humans associated with finasteride use, it’s still considered a medication that should be avoided during pregnancy. The current warnings around the potential for development harm come from animal studies. In animals, large doses of finasteride during the critical early stages of pregnancy (8-12 weeks) have been associated with abnormal development of male sex organs and abnormalities in the glands involved in semen production.
Alternatives to finasteride for hair loss that are safe while trying to conceive
There are alternatives to finasteride if you still want to treat your hair loss while trying to conceive or while your partner is pregnant. There are less potent, natural DHT blockers such as saw palmetto extract that may be helpful. Saw palmetto can be found in hair care products such as XYON’s Performance DHT Blocking Shampoo or Performance DHT Blocking Conditioner. Additionally, though the evidence isn’t definitive, ketoconazole, a common ingredient in some dandruff shampoos, may also be considered. In small scale studies, ketoconazole has been shown to stimulate hair growth with few side effects (El-Garf et al., 2019). These alternatives should not be considered equivalent to medications such as finasteride or minoxidil but may make sense as bridging solutions. If in doubt, please consult your doctor.
Takeaway: finasteride and male fertility
Based on available evidence, finasteride generally does not affect male fertility, but responses seem to be highly individual. Studies have shown that even if sperm production is affected by finasteride use, this is usually reversible. The most important thing to bear in mind is that exposure to, or use of finasteride during pregnancy may cause developmental harm. For these reasons, men who are planning a family or have a partner who is currently pregnant, or breastfeeding will want to consider taking extra steps to reduce the risk of exposing their partners. We encourage patients to discuss how having a baby might affect their hair loss journey with their doctor—healthier hair shouldn’t come at the cost of life’s milestones.
References:
El-Garf, A., Mohie, M., & Salah, E. (2019). Trichogenic effect of topical ketoconazole versus minoxidil 2% in female pattern hair loss: A clinical and trichoscopic evaluation. Biomedical Dermatology, 3(1). https://doi.org/10.1186/s41702-019-0046-y
MotherToBaby | Fact Sheets [Internet]. Brentwood (TN): Organization of Teratology Information Specialists (OTIS); 1994-. Finasteride. 2024 May. Available from: https://www.ncbi.nlm.nih.gov/books/NBK582707/
Overstreet, J. W., Fuh, V. L., Gould, J., Howards, S. S., Lieber, M. M., Hellstrom, W., Shapiro, S., Carroll, P., Corfman, R. S., Petrou, S., Lewis, R., Toth, P., Shown, T., Roy, J., Jarow, J. P., Bonilla, J., Jacobsen, C. A., Wang, D. Z., & Kaufman, K. D. (1999). Chronic treatment with finasteride daily does not affect spermatogenesis or semen production in young men. The Journal of Urology, 162(4), 1295–1300.
Samplaski, M. K., Lo, K., Grober, E., & Jarvi, K. (2013). Finasteride use in the male infertility population: effects on semen and hormone parameters. Fertility and Sterility, 100(6), 1542–1546. https://doi.org/10.1016/j.fertnstert.2013.07.2000
