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Androgenetic alopecia: effects of oral finasteride on hormone profile, reproduction and sexual function

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Androgenetic Alopecia (AGA) is a common non-cicatricial alopecia. AGA treatment with finasteride was reported to have sexological side effects and its induced hormonal alterations could damage spermatogenesis. Thus, in patients affected by AGA undergoing oral therapy with Finasteride 1 mg/die, we aimed to evaluate the presence of modification in sperm parameters, hormone profile and sexual function.


We retrospectively evaluated 55 male subjects aged 18–45 years with AGA who underwent systemic therapy with Finasteride 1 mg/die. Each subject underwent semen and blood hormone analysis, IIEF15 questionnaire administration at baseline (T0) at 6 (T6) and 12 (T12) months after the beginning of therapy and 1 year after treatment discontinuation (TD).


At T6 we detected a statistically significant worsening of total sperm number (232.4 ± 160.3 vs. 133.2 ± 82.0; p = 0.01 vs. T0) and abnormal forms (79.8 ± 6.0 vs. 82.7 ± 5.7; p < 0.05 vs. T0). No difference was found for all sperm parameters at T12 and T24, except for the percentage of abnormal forms (79.8 ± 6.0 vs. 82.6 ± 4.8; p < 0.05 T24 vs. T0). Testosterone levels were increased at T0 vs. T6 (22.1 ± 7.1 vs. 28.0 ± 8.0 ng/mL; p < 0.05). No significant differences of IIEF15 questionnaire were detected across the study.


Finasteride is associated with significant seminological and testosterone alterations, but no sexual dysfunctions were reported during treatment of these andrologically healthy subjects. Although, sperm parameters seem to return comparable to baseline after treatment discontinuation, it is advisable to perform a careful andrological evaluation before treatment.

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  1. 1.

    F. Lolli, F. Pallotti, A. Rossi et al. Androgenetic alopecia: a review. Endocrine 57, 9–17 (2017). https://doi.org/10.1007/s12020-017-1280-y

  2. 2.

    R. Hoffmann, Steroidogenic isoenzymes in human hair and their potential role in androgenetic alopecia. Dermatology 206, 85–95 (2003). https://doi.org/10.1159/000068475

  3. 3.

    V.A. Randall, N.A. Hibberts, M.J. Thornton et al. The hair follicle: a paradoxical androgen target organ. Horm. Res. 54, 243–250 (2000). https://doi.org/10.1159/000053266

  4. 4.

    V.A. Randall, Androgens and hair growth. Dermatol. Ther. 21, 314–328 (2008). https://doi.org/10.1111/j.1529-8019.2008.00214.x

  5. 5.

    K. Wang, D.D. Fan, S. Jin et al. Differential expression of 5-alpha reductase isozymes in the prostate and its clinical implications. Asian J. Androl. 16, 274–279 (2014). https://doi.org/10.4103/1008-682X.123664

  6. 6.

    M.A. Said, A. Mehta, The Impact of 5α-Reductase inhibitor use for male pattern hair loss on men’s health. Curr. Urol. Rep. 19, 1–6 (2018). https://doi.org/10.1007/s11934-018-0814-z

  7. 7.

    J.C. Nickel, Y. Fradet, R.C. Boake et al. Efficacy and safety of finasteride therapy for benign prostatic hyperplasia: results of a 2-year randomized controlled trial (the PROSPECT Study). CMAJ 155, 1251–1259 (1996)

  8. 8.

    L. Liu, S. Zhao, F. Li et al. Effect of 5α-Reductase inhibitors on sexual function: a meta-analysis and systematic review of randomized controlled trials. J. Sex. Med 13, 1297–1310 (2016). https://doi.org/10.1016/j.jsxm.2016.07.006

  9. 9.

    R.C. Melcangi, D. Santi, R. Spezzano et al. Neuroactive steroid levels and psychiatric and andrological features in post-finasteride patients. J. Steroid Biochem Mol. Biol. 171, 229–235 (2017). https://doi.org/10.1016/j.jsbmb.2017.04.003

  10. 10.

    J.B. Hamilton, Patterned loss of hair in man; types and incidence. Ann. N. Y Acad. Sci. 53, 708–728 (1951). https://doi.org/10.1111/j.1749-6632.1951.tb31971.x

  11. 11.

    O.T. Norwood, Male pattern baldness: classification and incidence. South Med J. 68, 1359–1365 (1975). https://doi.org/10.1097/00007611-197511000-00009

  12. 12.

    WHO. WHO Laboratory Manual for the Examination and Processing of Human Semen, 5th edn. Geneva (2010)

  13. 13.

    M. Spaziani, B. Mileno, F. Rossi et al. Endocrine and metabolic evaluation of classic Klinefelter syndrome and high-grade aneuploidies of sexual chromosomes with male phenotype: are they different clinical conditions? Eur. J. Endocrinol. 178, 343–352 (2018). https://doi.org/10.1530/EJE-17-0902

  14. 14.

    A. Rossi, A. Anzalone, M.C. Fortuna et al. Multi-therapies in androgenetic alopecia: review and clinical experiences. Dermatol. Ther. 29, 424–432 (2016). https://doi.org/10.1111/dth.12390

  15. 15.

    J.M. Hirshburg, P.A. Kelsey, C.A. Therrien et al. Adverse effects and safety of 5-alpha reductase inhibitors (finasteride, dutasteride): a systematic review. J. Clin. Aesthet. Dermatol. 9, 56–62 (2016)

  16. 16.

    J.W. Overstreet, V.L. Fuh, J. Gould et al. Chronic treatment with finasteride daily does not affect spermatogenesis or semen production in young men. J. Urol. 162, 1295–1300 (1999)

  17. 17.

    J.K. Amory, C. Wang, R.S. Swerdloff et al. The effect of 5alpha-reductase inhibition with dutasteride and finasteride on semen parameters and serum hormones in healthy men. J. Clin. Endocrinol. Metab. 92, 1659–1665 (2007). https://doi.org/10.1210/jc.2006-2203

  18. 18.

    S. Glina, P.A. Neves, R. Saade et al. Finasteride-associated male infertility. Rev. Hosp. Clin. Fac. Med Sao Paulo 59, 203–205 (2004). https://doi.org//S0041-87812004000400009

  19. 19.

    K. Chiba, K. Yamaguchi, F. Li et al. Finasteride-associated male infertility. Fertil. Steril. 95, 1786.e9–11 (2011). https://doi.org/10.1016/j.fertnstert.2010.12.001

  20. 20.

    H.Y.V. Tu, A. Zini, Finasteride-induced secondary infertility associated with sperm DNA damage. Fertil. Steril. 95, 2125.e13–4 (2011). https://doi.org/10.1016/j.fertnstert.2010.12.061

  21. 21.

    A. Salvarci, O. Istanbulluoglu, Secondary infertility due to use of low-dose finasteride. Int Urol. Nephrol. 45, 83–85 (2013). https://doi.org/10.1007/s11255-012-0315-9

  22. 22.

    F. Pallotti, D. Paoli, T. Carlini et al. Varicocele and semen quality: a retrospective case–control study of 4230 patients from a single centre. J. Endocrinol. Investig. 41, 185–192 (2018). https://doi.org/10.1007/s40618-017-0713-z

  23. 23.

    T. Carlini, D. Paoli, M. Pelloni et al. Sperm DNA fragmentation in Italian couples with recurrent pregnancy loss. Reprod. Biomed. Online 34, 58–65 (2017). https://doi.org/10.1016/j.rbmo.2016.09.014

  24. 24.

    M.K. Samplaski, K. Lo, E. Grober, K. Jarvi, Finasteride use in the male infertility population: effects on semen and hormone parameters. Fertil. Steril. 100, 1542–1546 (2013). https://doi.org/10.1016/j.fertnstert.2013.07.2000

  25. 25.

    M.S. Irwig, Androgen levels and semen parameters among former users of finasteride with persistent sexual adverse effects. JAMA Dermatol. 150, 1361–1363 (2014). https://doi.org/10.1001/jamadermatol.2014.1830

  26. 26.

    G. Corona, G. Tirabassi, D. Santi et al. Sexual dysfunction in subjects treated with inhibitors of 5alpha-reductase for benign prostatic hyperplasia: a comprehensive review and meta-analysis. Andrology 5, 671–678 (2017). https://doi.org/10.1111/andr.12353

  27. 27.

    R.S. Haber, A.K. Gupta, E. Epstein et al. Finasteride for androgenetic alopecia is not associated with sexual dysfunction: a survey-based, single-centre, controlled study. J. Eur. Acad. Dermatol. Venereol. 33, 1393–1397 (2019). https://doi.org/10.1111/jdv.15548

  28. 28.

    G.A. Zakhem, J.E. Goldberg, C.C. Motosko et al. Sexual dysfunction in men taking systemic dermatologic medication: a systematic review. J. Am. Acad. Dermatol. 81, 163–172 (2019). https://doi.org/10.1016/j.jaad.2019.03.043

  29. 29.

    R.C. Melcangi, V. Magnaghi, L. Martini, Steroid metabolism and effects in central and peripheral glial cells. J. Neurobiol. 40, 471–483 (1999)

  30. 30.

    Y.S. Shin, K.K. Karna, B.R. Choi, J.K. Park, Finasteride and erectile dysfunction in patients with benign prostatic hyperplasia or male androgenetic alopecia. World J. Mens. Health 37, 157–165 (2019). https://doi.org/10.5534/wjmh.180029

  31. 31.

    E.R. Coskuner, B. Ozkan, M.G. Culha, Sexual problems of men with androgenic alopecia treated with 5-Alpha reductase inhibitors. Sex. Med. Rev. 7, 277–282 (2019). https://doi.org/10.1016/j.sxmr.2018.07.003

  32. 32.

    M.C. Uygur, A.I. Arik, U. Altug, D. Erol, Effects of the 5 alpha-reductase inhibitor finasteride on serum levels of gonadal, adrenal, and hypophyseal hormones and its clinical significance: a prospective clinical study. Steroids 63, 208–213 (1998). https://doi.org/10.1016/s0039-128x(98)00005-1

  33. 33.

    A. Hoque, S. Yao, C. Till et al. Effect of finasteride on serum androstenedione and risk of prostate cancer within the prostate cancer prevention trial: differential effect on high- and low-grade disease. Urology 85, 616–620 (2015). https://doi.org/10.1016/j.urology.2014.11.024

  34. 34.

    B. Robaire, N.A. Henderson, Actions of 5α-reductase inhibitors on the epididymis. 250, 190–195 (2006). https://doi.org/10.1016/j.mce.2005.12.044

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This work was supported by a grant from the Italian Ministry of Education and Research (MIUR-PRIN 2015XCR88M_006) and the University of Rome “Sapienza” Faculty of Medicine.

Author contributions

Conception and design of the work: F.P., F.L., D.P.; Carried out semen analysis: D.P; Hormonal analysis: A.F.R; Draughting the article: F.P., G.S; Final approval of the version to be published: F.L., D.P; Acquisition and analysis of data: M.P., T.C., F.C., F.P.; Patients recruitment: F.L., A.R.; Revising the paper critically: A.L. All authors read and approved the final paper.

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Correspondence to Donatella Paoli.

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“All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards”.

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Pallotti, F., Senofonte, G., Pelloni, M. et al. Androgenetic alopecia: effects of oral finasteride on hormone profile, reproduction and sexual function. Endocrine (2020). https://doi.org/10.1007/s12020-020-02219-2

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  • AGA
  • Finasteride
  • Total sperm number
  • Erectile function
  • IIEF
  • Testosterone