Finasteride and Dutasteride for the Treatment of Male Androgenetic Alopecia: A Review of Efficacy and Reproductive Adverse Effects

Abstract

Finasteride and dutasteride are 5-α-reductase inhibitors (5-ARIs) used to treat androgenetic alopecia (AGA). This review evaluates the efficacy of 5-ARIs for treatment of men with AGA and the potential adverse effects on reproduction including sexual dysfunction, infertility, and teratogenicity. A broad literature review was conducted to search for publications on 5-ARI treatment in men with AGA. Hair counts, hair growth assessments, sexual adverse effects (erectile dysfunction, ejaculatory dysfunction, and decreased libido), change in sperm parameters (decreased sperm count, semen volume, sperm motility), and teratogenic drug concentration levels in semen were the measured outcomes of studies included in this literature review. Both finasteride and dutasteride are effective at treating hair loss in male AGA, with studies finding dutasteride was more efficacious than finasteride. Many studies reported sexual adverse effects of 5-ARIs that are uncommon and resolve spontaneously, although there remains no consensus with respect to the presence, severity, and duration of sexual adverse effects. 5-ARIs may have a negative impact on spermatogenesis although the clinical significance of this is unclear and discontinuation of these medications results in improved sperm parameters for most patients. Teratogenicity after paternal exposure is unlikely due to the low concentration of 5-ARIs absorbed in semen. Further research is needed to evaluate the effects of 5-ARI use on reproduction.