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

Richard Winkelmann, DO

Richard Winkelmann, DO

Director for Dermatology and Mohs Surgery
Optum Care
Los Angeles, CA

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


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