Genitourinary system, sexual function & fertility

See also: Brain, mind & behavior • Teratogenicity (birth abnormalities)Risk of prostate & bladder cancer

Penile, prostatic & testicular alterations

See also: Research review: Alterations to penile & prostatic tissueAdverse events affecting genitourinary system & sexual functionPenile disorders: diagnosis & treatment

Systematic review

Santana FFV, Lozi AA, Gonçalves RV, Da Silva J, Da Matta SLP. Comparative effects of finasteride and minoxidil on the male reproductive organs: a systematic review of in vitro and in vivo evidence. Toxicol Appl Pharmacol. 2023. doi:10.1016/j.taap.2023.116710 • PubMed

Human studies

Bauman TM, Sehgal PD, Johnson KA, et al. Finasteride treatment alters tissue specific androgen receptor expression in prostate tissues. Prostate. 2014. doi:10.1002/pros.22810 • PubMed

Carlisle M, Uloko M, Yee A, Goldstein S, Goldstein I. Vascular, neurologic and hormonal abnormalities in men with persistent sexual dysfunction after discontinuation of finasteride. J Urol. 2022 May 1;207(5S):e620–621. doi:10.1097/JU.0000000000002592.07Poster (PDF)

Khera M, Than JK, Anaissie J, et al. Penile vascular abnormalities in young men with persistent side effects after finasteride use for the treatment of androgenic alopecia. Transl Androl Urol. 2020. doi:10.21037/tau.2020.03.21 • PubMedPMC full text

Pharmacovigilance

Schifano N, Capogrosso P, Boeri L, et al. Are finasteride-related penile curvature/Peyronie’s disease Adverse Event Reports worthy of further clinical investigation? Disproportionality analysis based on both the Food and Drug Administration (FDA) and the European Medicines Agency (EMA) pharmacovigilance databases. Int J Impot Res. 2022. doi:10.1038/s41443-022-00568-2 • PubMed

Case reports

Berthold D, Lhermitte B, Uffer M, Doerfler A. Finasteride-related Leydig cell tumour: report of a case and literature review. Andrologia. 2012. doi:10.1111/j.1439-0272.2011.01214.x • PubMed

Fouda AM, Bazeed AM. Hematuria and hematospermia associated with the use of finasteride for the treatment of androgenic alopecia: a case report. Drug Saf Case Rep. 2017. doi:10.1007/s40800-017-0059-7PubMedPMC full text

Garreton AS, Valzacchi GR, Layus O. Post-finasteride syndrome: about 2 cases and review of the literature. Andrology-Open Access. 2016. doi:10.4172/2472-1212.1000170 • Journal site

Levy B, Teplitsky S, Kalaitzoglou E, Kahler S, Matheny JP, Saltzman AF. “Exogenous” 5 alpha reductase deficiency: a case report. Urology. 2023. doi:10.1016/j.urology.2023.05.001 • PubMed

Animal studies

da Silva MHA, Costa WS, Sampaio FJB, de Souza DB. Effects of dutasteride and tamsulosin on penile morphology in a rodent model. Int Braz J Urol. 2023. doi:10.1590/S1677-5538.IBJU.2022.0583 • Full text (PDF) • PubMed

Da Silva MHA, Medeiros JL Jr, Costa WS, Sampaio FJB, De Souza DB. Effects of the dutasteride and sildenafil association in the penis of a benign prostatic hyperplasia animal model. Aging Male. 2020. doi:10.1080/13685538.2019.1653839PubMed

Da Silva MHA, Costa WS, B Sampaio FJ, De Souza DB. The corpus cavernosum after treatment with dutasteride or finasteride: a histomorphometric study in a benign prostatic hyperplasia rodent model. Asian J Androl. 2018. doi:10.4103/aja.aja_28_18PubMedPMC full text

Diviccaro S, Herian M, Cioffi L, et al. Exploring rat corpus cavernosum alterations induced by finasteride treatment and withdrawal. Andrology. 2023. doi:10.1111/andr.13515 • PubMed

Enatsu N, Chiba K, Sumii K, et al. Dutasteride-mediated morphological changes in the genitourinary tract associated with altered expression patterns of the androgen and estrogen receptors in male rats. Andrology. 2017. doi:10.1111/andr.12297PubMed

Giatti S, Diviccaro S, Di Domizio A, et al. Finasteride inhibits epinephrine synthesis in humans: implication for sexual dysfunction. Endocrine Abstracts. 2022. doi:10.1530/endoabs.81.P448

Gul A, Altinay S, Kabasakal L, Yavuz A, Semercioz A, Serefoglu EC. Effect of tadalafil on penile nitric oxide synthase and corporal smooth muscle in rats under dutasteride treatment. Aging Male. 2020. doi:10.1080/13685538.2020.1739019 • PubMed

Kaya C, Ozyurek M, Turkeri LN. Comparison of microvessel densities in rat prostate tissues treated with finasteride, bicalutamide and surgical castration: a preliminary study. Int J Urol. 2005. doi:10.1111/j.1442-2042.2005.01005.xPubMed

Kilic S, Kolukcu E, Erdemir F, Benli I, Arici A. The effects of oral 5-alpha reductase inhibitors on penile intracavernosal pressures and penile morphology in rat model. Urology J. 2019. doi:10.22037/uj.v0i0.4164 • PubMed

Kolasa A, Marchlewicz M, Wenda-Różewicka L, Wiszniewska B. DHT deficiency perturbs the integrity of the rat seminiferous epithelium by disrupting tight and adherens junctions. Folia Histochem Cytobiol. 2011. doi:10.5603/fhc.2011.0010 • PubMed

Liu XD, Li H, Bu H, et al. [Effects of finasteride on capillary in the ventral prostate of rat]. Sichuan Da Xue Xue Bao Yi Xue Ban. 2004 Mar;35(2):226-8. Chinese. PubMed

Marghani BH, Ezz MA, Ateya AI, Fehaid A, Saleh RM, Rezk S. Comparative effects of finasteride and laser-irradiated silver nanoparticles on testicular function and histology in testosterone induced benign prostatic hyperplasia in rats. Life Sci. 2023. doi:10.1016/j.lfs.2023.121747PubMed

Nabil I, Eid AA, Yassin HA, Abouelrous RA, Solaiman AA. Protective role of hesperidin in finasteride-induced testicular toxicity in adult male wistar rats: insights into oxidative stress, apoptosis, and ultrastructure of seminiferous tubules. Reprod Toxicol. 2024. doi:10.1016/j.reprotox.2024.108535 • PubMed

Olayinka ET, Adewole KE. In vivo and in silico evaluation of the ameliorative effect of hesperidin on finasteride-induced testicular oxidative stress in Wistar rats. Toxicol Mech Methods. 2020. doi:10.1080/15376516.2020.1831123 • PubMed

Oztekin CV, Gur S, Abdulkadir NA, et al. Incomplete recovery of erectile function in rat after discontinuation of dual 5-alpha reductase inhibitor therapy. J Sex Med. 2012. doi:10.1111/j.1743-6109.2012.02759.x • PubMed

Oztekin CV, Yilmaz-Oral D, Kaya-Sezginer E, et al. Beneficial effects of human umbilical cord blood mononuclear cells on persistent erectile dysfunction after treatment of 5-alpha reductase inhibitor in rats. J Sex Med. 2021. doi:10.1016/j.jsxm.2021.02.005 • PubMed

Pinsky MR, Gur S, Tracey AJ, Harbin A, Hellstrom WJ. The effects of chronic 5-alpha-reductase inhibitor (dutasteride) treatment on rat erectile function. J Sex Med. 2011. doi:10.1111/j.1743-6109.2011.02425.x • PubMed

Rhoden EL, Gobbi D, Menti E, Rhoden C, Telöken C. Effects of the chronic use of finasteride on testicular weight and spermatogenesis in Wistar rats. BJU Int. 2002. doi:10.1046/j.1464-410x.2002.02785.x • PubMed

Shen ZJ, Chen SW, Lu YL, et al. Preliminary study on androgen dependence of calcitonin gene-related peptide in rat penis. Asian J Androl. 2005. doi:10.1111/j.1745-7262.2005.00003.xPubMed

Shen ZJ, Zhou XL, Lu YL, Chen ZD. Effect of androgen deprivation on penile ultrastructure. Asian J Androl. 2003. AbstractFull text (archive.org)PubMed

Sun S, Wang YC, Guo K, DU J, Zhou HJ, Ren AJ. [Finasteride inhibits microvascular density and VEGF expression in the seminal vesicle of rats]. Zhonghua Nan Ke Xue. 2018. Chinese. PubMed

Sung HH, Yu J, Kang SJ, et al. Persistent erectile dysfunction after discontinuation of 5-alpha reductase inhibitor therapy in rats depending on the duration of treatment. World J Mens Health. 2019. doi:10.5534/wjmh.180082 • PubMed

Zhang MG, Wang XJ, Shen ZJ, Gao PJ. Long-term oral administration of 5α-reductase inhibitor attenuates erectile function by inhibiting autophagy and promoting apoptosis of smooth muscle cells in corpus cavernosum of aged rats. Urology. 2013. doi:10.1016/j.urology.2013.02.045PubMed

Zhang MG, Wu W, Zhang CM, et al. Effects of oral finasteride on erectile function in a rat model. J Sex Med. 2012. doi:10.1111/j.1743-6109.2012.02661.x • PubMed

Semen, sperm, fertility and reproduction

Reviews & mini-reviews

Drobnis EZ, Nangia AK. 5α-reductase inhibitors (5ARIs) and male reproduction. Adv Exp Med Biol. 2017. doi:10.1007/978-3-319-69535-8_7 • PubMed

Gude D. Finasteride and male fertility. J Hum Reprod Sci. 2011. doi:10.4103/0974-1208.86093PubMedPMC full text

Hui EX, Huang X, Oon HH. Review of dermatologic medications and impact on male fertility, sexual dysfunction and teratogenicity. Andrology. 2022 Oct. doi:10.1111/andr.13236 • PubMed

Kortenkamp A. Which chemicals should be grouped together for mixture risk assessments of male reproductive disorders? Mol Cell Endocrinol. 2020. doi:10.1016/j.mce.2019.110581PubMed

Laborde E, Brannigan RE. Effect of 1-mg dose of finasteride on spermatogenesis and pregnancy. J Androl. 2010. doi:10.2164/jandrol.109.009381PubMedWiley Free Access

Millsop JW, Heller MM, Eliason MJ, Murase JE. Dermatological medication effects on male fertility. Dermatol Ther. 2013. doi:10.1111/dth.12069 • PubMed

Pole M, Koren G. Finasteride. Does it affect spermatogenesis and pregnancy? Can Fam Physician. 2001. PubMedPMC full text

Santana FFV, Lozi AA, Gonçalves RV, Da Silva J, Da Matta SLP. Comparative effects of finasteride and minoxidil on the male reproductive organs: a systematic review of in vitro and in vivo evidence. Toxicol Appl Pharmacol. 2023. doi:10.1016/j.taap.2023.116710 • PubMed

Velez D, Ohlander S. Medical therapies causing iatrogenic male infertility. Fertil Steril. 2021. doi:10.1016/j.fertnstert.2021.07.1202PubMed

Zakhem GA, Motosko CC, Mu EW, Ho RS. Infertility and teratogenicity after paternal exposure to systemic dermatologic medications: a systematic review. J Am Acad Dermatol. 2019. doi:10.1016/j.jaad.2018.09.031PubMed

Pharmacovigilance & drug-gene interaction study

Baldini S, Khattak A, Capogrosso P, et al. The possible role of prescribing medications, including central nervous system drugs, in contributing to male-factor infertility (MFI): assessment of the Food and Drug Administration (FDA) pharmacovigilance database. Brain Sci. 2023. doi:10.3390/brainsci13121652 • PubMed

Nacchia A, Franco A, Cicione A, et al. Medications mostly associated with ejaculatory disorders: assessment of the EudraVigilance (EV) and Food and Drug Administration (FDA) pharmacovigilance databases entries. Urology. 2024. doi:10.1016/j.urology.2023.12.021 • PubMed

Wu M, Yu Q, Li Q. Differences in reproductive toxicology between alopecia drugs: an analysis on adverse events among female and male cases. Oncotarget. 2016. doi:10.18632/oncotarget.12617 • PubMed

Human study

Birch MR, Dissing S, Skakkebæk NE, Rehfeld A. Finasteride interferes with prostaglandin-induced CatSper-signalling in human sperm. Reproduction. 2021. doi:10.1530/REP-20-0287 • PubMed

Case series

Collodel G, Scapigliati G, Moretti E. Spermatozoa and chronic treatment with finasteride: a TEM and FISH study. Arch Androl. 2007 Jul-Aug;53(4):229-33. doi:10.1080/01485010701426471PubMed

Irwig MS. Androgen levels and semen parameters among former users of finasteride with persistent sexual adverse effects. JAMA Dermatol. 2014. doi:10.1001/jamadermatol.2014.1830 • PubMed

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

Samplaski MK, Lo K, Grober E, Jarvi K. Finasteride use in the male infertility population: effects on semen and hormone parameters. Fertil Steril. 2013. doi:10.1016/j.fertnstert.2013.07.2000 • PubMed

[Letter] Hotaling JM. Finasteride and male infertility: a case for prospective collaborative research databases? Fertil Steril. 2013 Dec;100(6):1528-9. doi:10.1016/j.fertnstert.2013.08.023PubMed

Case reports

AlSaad D, Lee BH, Al-Obaidly S. Finasteride use during pregnancy and early neonatal outcome: a case report. Int J Clin Pharm. 2018. doi:10.1007/s11096-018-0661-5 • PubMed

Chiba K, Yamaguchi K, Li F, Ando M, Fujisawa M. Finasteride-associated male infertility. Fertil Steril. 2011. doi:10.1016/j.fertnstert.2010.12.001 • PubMed

Fouda AM, Bazeed AM. Hematuria and hematospermia associated with the use of finasteride for the treatment of androgenic alopecia: a case report. Drug Saf Case Rep. 2017. doi:10.1007/s40800-017-0059-7 • PubMed • PMC full text

Glina S, Neves PA, Saade R, Netto NR Jr, Soares JB, Galuppo AG. Finasteride-associated male infertility. Rev Hosp Clin Fac Med Sao Paulo. 2004. doi:10.1590/s0041-87812004000400009 • PubMed

Ibarra Vilar P, Marín Pérez A, Hernández Peñalver AI, et al. Genitales ambiguos tras toma de finasteride [Ambiguous genitalia after taking finasteride] [Abstract]. Presented at: XXVII Reunión de la Sociedad Ginecológica Murciana: Laparoscopia ginecológica. March 4, 2017; Hospital Comarcal del Noroeste, Caravaca de la Cruz, Spain. Spanish. Content warning: includes a sensitive image of a fetus. Abstract (Spanish) • English translation

Lechuga Sancho AM, Hernández Serrano R, González Casado I, Gracia Bouthelier R. Recién nacido con extrofia vesical y posible exposición intrauterina a finasterida [Newborn with bladder exstrophy associated with finasteride exposure]. An Pediatr (Barc). 2004 Nov;61(5):451-3. doi:10.1016/s1695-4033(04)78429-5 • PubMed • Unofficial translation

Liu KE, Binsaleh S, Lo KC, Jarvi K. Propecia-induced spermatogenic failure: a report of two cases. Fertil Steril. 2008. doi:10.1016/j.fertnstert.2007.08.026 • PubMed

Ricci G, Martinelli M, Luppi S, et al. Finasteride and fertility: case report and review of the literature. J Drugs Dermatol. 2012. doi:10.1111/dth.12069 • PubMed

Sallout BI, Al Wadi KA. Aphalangia possibly linked to unintended use of finasteride during early pregnancy. Ann Saudi Med. 2009. doi:10.4103/0256-4947.51805 • PubMed • PMC full text

Şalvarci A, Istanbulluoğlu O. Secondary infertility due to use of low-dose finasteride. Int Urol Nephrol. 2013. doi:10.1007/s11255-012-0315-9 • PubMed

Tu HY, Zini A. Finasteride-induced secondary infertility associated with sperm DNA damage. Fertil Steril. 2011. doi:10.1016/j.fertnstert.2010.12.061 • PubMed

Clinical trials

[⚠️ GlaxoSmithKline-funded] Amory JK, Wang C, Swerdloff RS, et al. The effect of 5alpha-reductase inhibition with dutasteride and finasteride on semen parameters and serum hormones in healthy men [published correction appears in J Clin Endocrinol Metab. 2007 Nov;92(11):4379]. J Clin Endocrinol Metab. 2007. doi:10.1210/jc.2006-2203 • PubMed

[⚠️ Merck-funded] Overstreet JW, Fuh VL, Gould J, et al. Chronic treatment with finasteride daily does not affect spermatogenesis or semen production in young men. J Urol. 1999 Oct;162(4):1295-300. PubMed

Animal studies

Angrimani DSR, Bicudo LC, Llamas Luceño N, et al. Does finasteride treatment for benign prostatic hyperplasia influence sperm DNA integrity in dogs? Basic Clin Androl. 2020. doi:10.1186/s12610-020-00108-2 • PubMed

Chen X, Feng H, El-Kott AF, Abd-Ella EM. Origanum vulgare L. leaves extract alleviates testis and sperm damages induced by finasteride: Biochemical, Immunohistological and apoptosis genes based evidences. Andrologia. 2020. doi:10.1111/and.13823 • PubMed

Clark RL, Antonello JM, Grossman SJ, et al. External genitalia abnormalities in male rats exposed in utero to finasteride, a 5 alpha-reductase inhibitor. Teratology. 1990. doi:10.1002/tera.1420420111 • PubMed

Cukierski MA, Sina JL, Prahalada S, et al. Decreased fertility in male rats administered the 5 alpha-reductase inhibitor, finasteride, is due to deficits in copulatory plug formation. Reprod Toxicol. 1991. doi:10.1016/0890-6238(91)90094-v • PubMed

Flores RB, Angrimani DSR, Brito MM, et al. Frozen-thawed sperm analysis of benign prostatic hyperplasia dogs treated with finasteride. Front Vet Sci. 2022. doi:10.3389/fvets.2022.901943 • PubMedPMC full text

Garcia PV, Barbieri MF, Perobelli JE, et al. Morphometric-stereological and functional epididymal alterations and a decrease in fertility in rats treated with finasteride and after a 30-day post-treatment recovery period. Fertil Steril. 2012. doi:10.1016/j.fertnstert.2012.03.025 • PubMed

García-García M, Sánchez-Hernández M, García-Hernández MP, García-Ayala A, Chaves-Pozo E. Role of 5α-dihydrotestosterone in testicular development of gilthead seabream following finasteride administration. J Steroid Biochem Mol Biol. 2017. doi:10.1016/j.jsbmb.2017.07.024 • PubMed

Iguer-Ouada M, Verstegen JP. Effect of finasteride (Proscar MSD) on seminal composition, prostate function and fertility in male dogs. J Reprod Fertil Suppl. 1997. PubMed

Jarvi K. Hairless or fertile? Finasteride leads to epididymal changes and infertility in rats. Fertil Steril. 2012. doi:10.1016/j.fertnstert.2012.04.016 • PubMed

Jia Y, Cue YG, Wang XD, et al. [Effect of selective 5alpha-reductase inhibitor or/and testosterone undecanoate on the reproductive function of male rats]. Zhonghua Nan Ke Xue. 2005. Chinese. PubMed

Kolasa A, Marchlewicz M, Kurzawa R, et al. The expression of inducible nitric oxide synthase (iNOS) in the testis and epididymis of rats with a dihydrotestosterone (DHT) deficiency. Cell Mol Biol Lett. 2009. doi:10.2478/s11658-009-0019-z • PubMed • PMC full text

Kolasa A, Marchlewicz M, Wenda-Różewicka L, Wiszniewska B. DHT deficiency perturbs the integrity of the rat seminiferous epithelium by disrupting tight and adherens junctions. Folia Histochem Cytobiol. 2011. doi:10.5603/fhc.2011.0010 • PubMed

Kolasa A, Rogińska D, Rzeszotek S, Machaliński B, Wiszniewska B. Paternal finasteride treatment can influence the testicular transcriptome profile of male offspring—preliminary study. Curr Issues Mol Biol. 2021. doi:10.3390/cimb43020062 • PubMed

Kolasa-Wolosiuk A, Misiakiewicz-Has K, Baranowska-Bosiacka I, Gutowska I, Wiszniewska B. Androgen levels and apoptosis in the testis during postnatal development of finasteride-treated male rat offspring. Folia Histochem Cytobiol. 2015. doi:10.5603/fhc.a2015.0025 • PubMed

Kur P, Kolasa-Wołosiuk A, Grabowska M, et al. The postnatal offspring of finasteride-treated male rats shows hyperglycaemia, elevated hepatic glycogen storage and altered GLUT2, IR, and AR expression in the liver. Int J Mol Sci. 2021. doi:10.3390/ijms22031242 • PubMed

Mohebali S, Hayati Roodbari N, Hajihosseini R, Parivar K. The effects of finasteride on the expression of DAZL, TSGA10, SYCP3, PRM2 genes during spermatogenesis in testes of NMRI mice. Eur Rev Med Pharmacol Sci. 2020. doi:10.26355/eurrev_202008_22503 • PubMed

Nabil I, Eid AA, Yassin HA, Abouelrous RA, Solaiman AA. Protective role of hesperidin in finasteride-induced testicular toxicity in adult male wistar rats: insights into oxidative stress, apoptosis, and ultrastructure of seminiferous tubules. Reprod Toxicol. 2024. doi:10.1016/j.reprotox.2024.108535 • PubMed

O’Donnell L, Pratis K, Stanton PG, Robertson DM, McLachlan RI. Testosterone-dependent restoration of spermatogenesis in adult rats is impaired by a 5alpha-reductase inhibitor. J Androl. 1999 Jan-Feb;20(1):109-17. PubMed

Paris JJ, Brunton PJ, Russell JA, Walf AA, Frye CA. Inhibition of 5α-reductase activity in late pregnancy decreases gestational length and fecundity and impairs object memory and central progestogen milieu of juvenile rat offspring. J Neuroendocrinol. 2011. doi:10.1111/j.1365-2826.2011.02219.x • PubMed

Parivar K, Yaghmaei P, Sekhavati S. The role and effect of finasteride on the spermatogenesis, prostate gland and epididym of mature NMRI mouse in in vivo and in vitro conditions. Med Sci J Islam Azad Univ. 2008;179:2333-8. PDF at iautmu.ac.ir

Rhoden EL, Gobbi D, Menti E, Rhoden C, Telöken C. Effects of the chronic use of finasteride on testicular weight and spermatogenesis in Wistar rats. BJU Int. 2002. doi:10.1046/j.1464-410x.2002.02785.x • PubMed

Robaire B, Henderson NA. Actions of 5alpha-reductase inhibitors on the epididymis. Mol Cell Endocrinol. 2006. doi:10.1016/j.mce.2005.12.044 • PubMed

Serga, CNK. The effect of different doses of finasteride on sperm morphology and motility and reactive oxygen species concentrations in rats. Med J Cairo Univ. 2009 Sep;77(1):439-447. PDF on semanticscholar.org

Shalaby AM, Alabiad MA, El Shaer DF. Resveratrol ameliorates the seminiferous tubules damages induced by finasteride in adult male rats. Microsc Microanal. 2020. doi:10.1017/S1431927620024514 • PubMed

Sun S, Wang YC, Guo K, DU J, Zhou HJ, Ren AJ. [Finasteride inhibits microvascular density and VEGF expression in the seminal vesicle of rats]. Zhonghua Nan Ke Xue. 2018. Chinese. PubMed

Urbatzka R, Watermann B, Lutz I, Kloas W. Exposure of Xenopus laevis tadpoles to finasteride, an inhibitor of 5-alpha reductase activity, impairs spermatogenesis and alters hypophyseal feedback mechanisms. J Mol Endocrinol. 2009. doi:10.1677/JME-09-0058 • PubMed • Free access

Wang XD, Jia Y, Cui YG, et al. [Effect of large-dosage of 5alpha-reductase inhibitors on the spermatogenesis of male rats]. Zhonghua Nan Ke Xue. 2005 Sep;11(9):652-4. Chinese. PubMed

Wise LD, Minsker DH, Cukierski MA, et al. Reversible decreases of fertility in male Sprague-Dawley rats treated orally with finasteride, a 5 alpha-reductase inhibitor. Reprod Toxicol. 1991. doi:10.1016/0890-6238(91)90092-t • PubMed

Sexual dysfunction

See also: Lasting, multi-system dysfunctions, which may include sexual dysfunction.

Trials & prospective studies

[⚠️ Merck-funded] Cunningham GR, Hirshkowitz M. Inhibition of steroid 5 alpha-reductase with finasteride: sleep-related erections, potency, and libido in healthy men. J Clin Endocrinol Metab. 1995. doi:10.1210/jcem.80.6.7775644PubMed

Taniguchi H, Inoue T, Kawa G, et al. Evaluation of sexual function after dutasteride treatment in patients with once-negative prostate biopsy and benign prostate hyperplasia. Urologia Journal. 2023. doi:10.1177/03915603231163201 • PubMed

Case series, surveys & cohort studies

Carlisle M, Uloko M, Yee A, Goldstein S, Goldstein I. Vascular, neurologic and hormonal abnormalities in men with persistent sexual dysfunction after discontinuation of finasteride. J Urol. 2022 May 1;207(5S):e620–621. doi:10.1097/JU.0000000000002592.07

Haber RS, Gupta AK, Epstein E, Carviel JL, Foley KA. Finasteride for androgenetic alopecia is not associated with sexual dysfunction: a survey-based, single-centre, controlled study. J Eur Acad Dermatol Venereol. 2019. doi:10.1111/jdv.15548 • PubMed

Lauck KC, Limmer A, Harris P, Kivelevitch D. Sexual dysfunction with 5-alpha-reductase inhibitor therapy for androgenetic alopecia: a global propensity score matched retrospective cohort study. J Am Acad Dermatol. 2024. doi:10.1016/j.jaad.2024.03.019 • PubMed

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

Sadeghi-Nejad H, Sherman N, Lue J. Comparison of finasteride and alpha-blockers as independent risk factors for erectile dysfunction. Int J Clin Pract. 2003. PubMed

Tosti A, Pazzaglia M, Soli M, et al. Evaluation of sexual function with an international index of erectile function in subjects taking finasteride for androgenetic alopecia. Arch Dermatol. 2004. doi:10.1001/archderm.140.7.857PubMed

Reviews & meta-analyses

Andrade C. Why odds ratios can be tricky statistics: the case of finasteride, dutasteride, and sexual dysfunction. J Clin Psychiatry. 2018. doi:10.4088/JCP.18f12641 • PubMed

Anitha B, Inamadar AC, Ragunatha S. Finasteride-its impact on sexual function and prostate cancer. J Cutan Aesthet Surg. 2009. doi:10.4103/0974-2077.53093. Journal site • PubMed

Bearelly P, Avellino GJ. The role of benign prostatic hyperplasia treatments in ejaculatory dysfunction. Fertil Steril. 2021. doi:10.1016/j.fertnstert.2021.07.1199 • PubMed

Bortnick EM, Simma-Chiang V, Kaplan SA. Long-term consequences of medical therapy for benign prostatic hyperplasia. Rev Urol. 2019. PubMed • PMC full text

Coskuner ER, Ozkan B, Culha MG. Sexual problems of men with androgenic alopecia treated with 5-alpha reductase inhibitors. Sex Med Rev. 2019. doi:10.1016/j.sxmr.2018.07.003 • PubMed

Erdemir F, Harbin A, Hellstrom WJ. 5-alpha reductase inhibitors and erectile dysfunction: the connection. J Sex Med. 2008. doi:10.1111/j.1743-6109.2008.01001.x • PubMed

Fertig RM, Gamret AC, Darwin E, Gaudi S. Sexual side effects of 5-α-reductase inhibitors finasteride and dutasteride: A comprehensive review. Dermatol Online J. 2017 Nov 11. Journal site • PubMed

Gacci M, Ficarra V, Sebastianelli A, et al. Impact of medical treatments for male lower urinary tract symptoms due to benign prostatic hyperplasia on ejaculatory function: a systematic review and meta-analysis. J Sex Med. 2014. doi:10.1111/jsm.12525 • PubMed

Gur S, Kadowitz PJ, Hellstrom WJ. Effects of 5-alpha reductase inhibitors on erectile function, sexual desire and ejaculation. Expert Opin Drug Saf. 2013. doi:10.1517/14740338.2013.742885 • PubMed

Hui EX, Huang X, Oon HH. Review of dermatologic medications and impact on male fertility, sexual dysfunction and teratogenicity. Andrology. 2022 Oct. doi:10.1111/andr.13236 • PubMed

La Torre A, Giupponi G, Duffy D, Conca A, Cai T, Scardigli A. Sexual dysfunction related to drugs: a critical review. Part V: α-blocker and 5-ARI drugs. Pharmacopsychiatry. 2016. doi:10.1055/s-0035-1565100 • PubMed

La Torre A, Palleria C, Tamanini I, et al. Sexual dysfunctions related to drugs used in the management of lower urinary tract symptoms due to benign prostatic hyperplasia: a narrative review on α-blockers and 5-alpha reductase inhibitors. Uro. 2021. doi:10.3390/uro1030012

Lee S, Lee YB, Choe SJ, Lee WS. Adverse sexual effects of treatment with finasteride or dutasteride for male androgenetic alopecia: a systematic review and meta-analysis. Acta Derm Venereol. 2019. doi:10.2340/00015555-3035 • PubMed

Shin YS, Karna KK, Choi BR, Park JK. Finasteride and erectile dysfunction in patients with benign prostatic hyperplasia or male androgenetic alopecia. World J Mens Health. 2019. doi:10.5534/wjmh.180029 • PubMed

Traish AM. Negative impact of testosterone deficiency and 5α-reductase inhibitors therapy on metabolic and sexual function in men. Adv Exp Med Biol. 2017. doi:10.1007/978-3-319-70178-3_22 • PubMed

Zakhem GA, Goldberg JE, Motosko CC, Cohen BE, Ho RS. Sexual dysfunction in men taking systemic dermatologic medication: A systematic review. J Am Acad Dermatol. 2019. doi:10.1016/j.jaad.2019.03.043 • PubMed

Zhang JJ, Shi X, Wu T, et al. Sexual, physical, and overall adverse effects in patients treated with 5α-reductase inhibitors: a systematic review and meta-analysis. Asian J Androl. 2022. doi:10.4103/aja202171 • PubMed

Epidemiology & pharmacovigilance

Gupta AK, Carviel J, Gupta MA, Shear NH. Assessing dutasteride-associated sexual dysfunction using the U.S. Food and Drug Administration Adverse Event Reporting System. J Eur Acad Dermatol Venereol. 2018. doi:10.1111/jdv.14728 • PubMed

Gupta AK, Carviel J, MacLeod MA, Shear N. Assessing finasteride-associated sexual dysfunction using the FAERS database. J Eur Acad Dermatol Venereol. 2017. doi:10.1111/jdv.14223 • PubMed

[⚠️ JC Nickel was an investigator in two Merck-sponsored trials of finasteride – view details] Hagberg KW, Divan HA, Persson R, Nickel JC, Jick SS. Risk of erectile dysfunction associated with use of 5-α reductase inhibitors for benign prostatic hyperplasia or alopecia: population based studies using the Clinical Practice Research Datalink. BMJ. 2016. doi:10.1136/bmj.i4823 • PubMed

Nacchia A, Franco A, Cicione A, et al. Medications mostly associated with ejaculatory disorders: assessment of the EudraVigilance (EV) and Food and Drug Administration (FDA) pharmacovigilance databases entries. Urology. 2024. doi:10.1016/j.urology.2023.12.021 • PubMed

Nguyen DD, Herzog P, Cone EB, et al. Disproportional signal of sexual dysfunction reports associated with finasteride use in young men with androgenetic alopecia: A pharmacovigilance analysis of VigiBase. J Am Acad Dermatol. 2022. doi:10.1016/j.jaad.2022.03.037 • PubMed

Valeiro C, Matos C, Scholl J, van Hunsel F. Drug-induced sexual dysfunction: an analysis of reports to a national pharmacovigilance database. Drug Saf. 2022. doi:10.1007/s40264-022-01174-3 • PubMed

Wu M, Yu Q, Li Q. Differences in reproductive toxicology between alopecia drugs: an analysis on adverse events among female and male cases. Oncotarget. 2016. doi:10.18632/oncotarget.12617 • PubMed

Animal studies

Diviccaro S, Herian M, Cioffi L, et al. Exploring rat corpus cavernosum alterations induced by finasteride treatment and withdrawal. Andrology. 2023. doi:10.1111/andr.13515 • PubMed

Giatti S, Diviccaro S, Di Domizio A, Cioffi L, Falvo E, Caruso D, Contini A, Melcangi RC. Finasteride inhibits epinephrine synthesis in humans: implication for sexual dysfunction. Endocrine Abstracts. 2022 May 21;81:P448. doi:10.1530/endoabs.81.P448

Magri ML, Gottardo MF, Zárate S, et al. Opposite effects of dihydrotestosterone and estradiol on apoptosis in the anterior pituitary gland from male rats. Endocrine. 2016 Mar;51(3):506-16. doi:10.1007/s12020-015-0719-2 | PubMed [Included here because effects of finasteride on pituitary might contribute to sexual dysfunction.]

Parivar K, Yaghmaei P, Sekhavati S. The role and effect of finasteride on the spermatogenesis, prostate gland and epididymis of mature NMRI mouse in in vivo and in vitro conditions. Med Sci J Islam Azad Univ. 2008;179:2333-8. PDF at iautmu.ac.ir

Pinsky MR, Gur S, Tracey AJ, Harbin A, Hellstrom WJ. The effects of chronic 5-alpha-reductase inhibitor (dutasteride) treatment on rat erectile function. J Sex Med. 2011. doi:10.1111/j.1743-6109.2011.02425.x • PubMed

Zhang MG, Wang XJ, Shen ZJ, Gao PJ. Long-term oral administration of 5α-reductase inhibitor attenuates erectile function by inhibiting autophagy and promoting apoptosis of smooth muscle cells in corpus cavernosum of aged rats. Urology. 2013. doi:10.1016/j.urology.2013.02.045 • PubMed

See also: Research on lasting dysfunctions after taking finasteride or dutasteride