QWhat do you tell your male Androgenetic Alopecia (AGA) patients about sexual dysfunction from finasteride?

Finasteride is an FDA-approved medication used for the treatment of benign prostate hyperplasia and androgenic alopecia in men.¹ Common adverse effects associated with finasteride include loss of libido, erectile dysfunction (2% to 4%), decreased ejaculatory volume, and gynecomastia.² Although sexual side effects typically improve following cessation of the drug, recent reports suggest that this dysfunction may be permanent in some patients resulting what is now becoming called Post-finasteride Syndrome.³

Although very uncommon and not thoroughly studied, I mention the potential for permanent sexual dysfunction to every patient while discussing the medicine. Hair loss can a very emotionally traumatic event for a male patient experiencing AGA and adding a therapeutic agent with the potential for permanent sexual dysfunction requires thorough education and discussion of finasteride’s risks and benefits. I have never had a patient fail to start the medicine even with the knowledge that sexual dysfunction may be permanent but always mention it. I consider it more prudent to ensure the patient discontinues the medicine while trying to conceive with their partner due to its potential for negative effects on male fertility.¹

References:

1. Zito et al. Stat Pearls. 2022.
2. Fertig et al. Dermatol Online J. 2011
3. Traish AM. Fertil Steril. 2020.