Lasting, multi-system dysfunctions (separate page)
Sexual & reproductive: Penile alterations | Semen & fertility | Sexual dysfunction
Mind & behavior: Behavior | Cognition | Neuropsychiatric adverse effects
Ocular & dental: Ocular toxicity | Dental adverse effects
Hepatic, metabolic & renal: Liver & metabolism | Kidneys
Endocrine: Gynecomastia
Genetic: DNA damage
Special topic: Adverse effects in women

Updated May 12, 2022

Lasting, multi-system dysfunctions

See Research on lasting dysfunctions after taking finasteride or dutasteride

Sexual function & reproductive system

Penile, prostatic & testicular alterations

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.0000000000002592.07

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;9(3):1201-1209. doi:10.21037/tau.2020.03.21 | PubMed | PMC 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 May 5. doi:10.1038/s41443-022-00568-2 • PubMed

Case report

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 Oct 31;4(1):14. doi:10.1007/s40800-017-0059-7 | PubMed | PMC full text

Animal studies

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:10.1080/13685538.2019.1653839 (full text available) | PubMed

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_18 | PubMed | PMC full text

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.12297 | 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

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 Jun;23(2):161-167. doi:10.1080/13685538.2020.1739019 | PubMed

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; 16(2):205–211. 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;49(1):62-71. 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

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 Oct 1:1-28. doi:10.1080/15376516.2020.1831123 | 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;8(11):3066–3074. 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 Jun;89(9):961-3. 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 Mar;7(1):55-9. doi:10.1111/j.1745-7262.2005.00003.x | PubMed

Shen ZJ, Zhou XL, Lu YL, Chen ZD. Effect of androgen deprivation on penile ultrastructure. Asian J Androl. 2003 Mar;5(1):33-6. Abstract | Full text | 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;37(2):240–248. 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.2013.02.045 | PubMed

Zhang MG, Wu W, Zhang CM, et al. Effects of oral finasteride on erectile function in a rat model. J Sex Med. 2012 May;9(5):1328-36. doi:10.1111/j.1743-6109.2012.02661.x | PubMed

See also: ‘Sexual anatomy & physiology’ category in the summary table of adverse event data.

Semen, sperm, fertility and reproduction

Human study

Birch MR, Dissing S, Skakkebæk NE, Rehfeld A. Finasteride interferes with prostaglandin-induced CatSper-signalling in human sperm. Reproduction. 2021 Mar 1;161(5):561-572. doi:10.1530/REP-20-0287 | PubMed

Reviews and mini-reviews

Gude D. Finasteride and male fertility. J Hum Reprod Sci. 2011 May;4(2):101-2. doi:10.4103/0974-1208.86093 | PubMed | PMC full text

Kortenkamp A. Which chemicals should be grouped together for mixture risk assessments of male reproductive disorders? Mol Cell Endocrinol. 2020 Jan 1;499:110581. doi:10.1016/j.mce.2019.110581 | PubMed

Laborde E, Brannigan RE. Effect of 1-mg dose of finasteride on spermatogenesis and pregnancy. J Androl. 2010 Mar-Apr;31(2):e1-2. doi:10.2164/jandrol.109.009381 | PubMed | Wiley Free Access

Millsop JW, Heller MM, Eliason MJ, Murase JE. Dermatological medication effects on male fertility. Dermatol Ther. 2013;26(4):337–346. doi:10.1111/dth.12069 | PubMed

Pole M, Koren G. Finasteride. Does it affect spermatogenesis and pregnancy?. Can Fam Physician. 2001;47:2469–2470. PubMed | PMC full text

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

Velez D, Ohlander S. Medical therapies causing iatrogenic male infertility. Fertil Steril. 2021 Sep;116(3):618-624. doi:10.1016/j.fertnstert.2021.07.1202 | PubMed

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 Apr;80(4):957-969. doi:10.1016/j.jaad.2018.09.031 | PubMed

Case series

Irwig MS. Androgen levels and semen parameters among former users of finasteride with persistent sexual adverse effects. JAMA Dermatol. 2014;150(12):1361-1363. doi:10.1001/jamadermatol.2014.1830 | 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;100(6):1542–1546. 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.2013.08.023 | PubMed

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 Aug;40(4):803-805. 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;95(5):. doi:10.1016/j.fertnstert.2010.12.001 | PubMed

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 Aug;59(4):203-5. doi:10.1590/s0041-87812004000400009 | PubMed

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;90(3):. doi:10.1016/j.fertnstert.2007.08.026 | PubMed

Şalvarci A, Istanbulluoğlu O. Secondary infertility due to use of low-dose finasteride. Int Urol Nephrol. 2013;45(1):83-85. doi:10.1007/s11255-012-0315-9 | PubMed

Tu HY, Zini A. Finasteride-induced secondary infertility associated with sperm DNA damage. Fertil Steril. 2011;95(6):2125.e13–2125.e14. doi:10.1016/j.fertnstert.2010.12.061 | PubMed

Clinical trials

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;92(5):1659–1665. doi:10.1210/jc.2006-2203 | PubMed

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;30:9. 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 Sep 23:e13823. 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 Jul;42(1):91-100. 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;5(4):353-62. doi:10.1016/0890-6238(91)90094-v | PubMed

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 Jun;97(6):1444-51. 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;174:48-55. 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;51:139-49 | PubMed

Jarvi K. Hairless or fertile? Finasteride leads to epididymal changes and infertility in rats. Fertil Steril. 2012 Jun;97(6):1298. 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 Jan;11(1):38-41. 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, 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 Jul 31;43(2):868-886. 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;53(3):236-48. 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 Jan 27;22(3):1242. 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;24(15):8160-8163. doi:10.26355/eurrev_202008_22503 | 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;23(11):1079-1090. 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

Robaire B, Henderson NA. Actions of 5alpha-reductase inhibitors on the epididymis. Mol Cell Endocrinol. 2006;250(1-2):190–195. 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. Sept 2009;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 Oct 5:1-11. doi:10.1017/S1431927620024514 | 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 Nov;43(5):209-19. 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;5(4):337-46. doi:10.1016/0890-6238(91)90092-t | PubMed

Sexual dysfunction

See also a bibliography on complex, multi-system dysfunctions, which may include sexual dysfunction.

Andrade C. Why Odds Ratios Can Be Tricky Statistics: The Case of Finasteride, Dutasteride, and Sexual Dysfunction. J Clin Psychiatry. 2018;79(6). doi:10.4088/JCP.18f12641 | PubMed

Bearelly P, Avellino GJ. The role of benign prostatic hyperplasia treatments in ejaculatory dysfunction. Fertil Steril. 2021 Sep;116(3):611-617. doi:10.1016/j.fertnstert.2021.07.1199 | PubMed

Coskuner ER, Ozkan B, Culha MG. Sexual Problems of Men With Androgenic Alopecia Treated With 5-Alpha Reductase Inhibitors. Sex Med Rev. 2019;7(2):277-282. doi:10.1016/j.sxmr.2018.07.003 | PubMed

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;80(6):1934-1940. doi:10.1210/jcem.80.6.7775644 | PubMed

Erdemir F, Harbin A, Hellstrom WJ. 5-alpha reductase inhibitors and erectile dysfunction: the connection. J Sex Med. 2008;5(12):2917-2924. 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;23(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 Jun. DOI • PubMed

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;32(8):1373-1376. 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;31(6):1069-1075. doi:10.1111/jdv.14223 | 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;12(1):81-90. doi:10.1517/14740338.2013.742885 | PubMed

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;33(7):1393–1397. doi:10.1111/jdv.15548 | PubMed

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;354:i4823. doi:10.1136/bmj.i4823 | 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;49(1):3-13. doi:10.1055/s-0035-1565100 | PubMed

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;99(1):12–17. doi:10.2340/00015555-3035 | 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 Mar 26. doi:10.1016/j.jaad.2022.03.037 • PubMed

Pallotti F, Senofonte G, Pelloni M, et al. Androgenetic alopecia: effects of oral finasteride on hormone profile, reproduction and sexual function. Endocrine. 2020 Feb 12. doi:10.1007/s12020-020-02219-2 | 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;140(7):857-858. doi:10.1001/archderm.140.7.857 | 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;57(6):484-487. 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;37(2):157–165. 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;1043:473-526. doi:10.1007/978-3-319-70178-3_22 | 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 Apr 7. doi:10.1007/s40264-022-01174-3 | 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;81(1):163-172. doi:10.1016/j.jaad.2019.03.043 | PubMed

Animal studies

Mind & behavior

Behavior & stress response

Animal studies

Bartolomé I, Llidó A, Darbra S, Pallarès M. Early postnatal allopregnanolone levels alteration and adult behavioral disruption in rats: Implication for drug abuse. Neurobiol Stress. 2019;12:100208. Published 2019 Dec 27. doi:10.1016/j.ynstr.2019.100208 | PubMed

Diviccaro S, Giatti S, Borgo F, et al. Treatment of male rats with finasteride, an inhibitor of 5alpha-reductase enzyme, induces long-lasting effects on depressive-like behavior, hippocampal neurogenesis, neuroinflammation and gut microbiota composition. Psychoneuroendocrinology. 2019;99:206-215. doi:10.1016/j.psyneuen.2018.09.021 | PubMed

Frau R, Pillolla G, Bini V, Tambaro S, Devoto P, Bortolato M. Inhibition of 5α-reductase attenuates behavioral effects of D1-, but not D2-like receptor agonists in C57BL/6 mice. Psychoneuroendocrinology. 2013 Apr;38(4):542-51. doi:10.1016/j.psyneuen.2012.07.014 | PubMed

Godar SC, Cadeddu R, Floris G, et al. The Steroidogenesis Inhibitor Finasteride Reduces the Response to Both Stressful and Rewarding Stimuli. Biomolecules. 2019;9(11):749. doi:10.3390/biom9110749 | PubMed

Li L, Kang YX, Ji XM, et al. Finasteride inhibited brain dopaminergic system and open-field behaviors in adolescent male rats. CNS Neurosci Ther. 2018;24(2):115-125. doi:10.1111/cns.12781

Mann PE. Finasteride delays the onset of maternal behavior in primigravid rats. Physiol Behav. 2006;88(4-5):333-338. doi:10.1016/j.physbeh.2006.04.008 | PubMed

Maurice-Gélinas C, Deslauriers J, Monpays C, Sarret P, Grignon S. The 5α-reductase inhibitor finasteride increases suicide-related aggressive behaviors and blocks clozapine-induced beneficial effects in an animal model of schizophrenia. Physiol Behav. 2018;191:65–72. doi:10.1016/j.physbeh.2018.03.036 | PubMed

Cognition & memory

Ganzer CA, Jacobs AR, Iqbal F. Persistent sexual, emotional, and cognitive impairment post-finasteride: a survey of men reporting symptoms. Am J Mens Health. 2015;9(3):222-228. doi:10.1177/1557988314538445 | PubMed

Kim YJ, Tae BS, Bae JH. Cognitive Function and Urologic Medications for Lower Urinary Tract Symptoms. Int Neurourol J. 2020 Sep;24(3):231-240. doi:10.5213/inj.2040082.041 | PubMed

Welk B, McArthur E, Ordon M, Morrow SA, Hayward J, Dixon S. The risk of dementia with the use of 5 alpha reductase inhibitors. J Neurol Sci. 2017;379:109-111. doi:10.1016/j.jns.2017.05.064 | PubMed

Animal studies

Ahire A, Nair, KP, Shankaranarayana Rao BS, Srikumar BN. The potential involvement of cholinergic system in finasteride induced cognitive dysfunction. Psychoneuroendocrinology. 2021 Feb;124:105066. doi:10.1016/j.psyneuen.2020.105066 | PubMed

Mendell AL, Creighton SD, Wilson HA, et al. Inhibition of 5α Reductase Impairs Cognitive Performance, Alters Dendritic Morphology and Increases Tau Phosphorylation in the Hippocampus of Male 3xTg-AD Mice. Neuroscience. 2020 Mar 1;429:185-202. doi:10.1016/j.neuroscience.2020.01.011 | PubMed

Depression, anxiety and other neuropsychiatric adverse events

Ali AK, Heran BS, Etminan M. Persistent Sexual Dysfunction and Suicidal Ideation in Young Men Treated with Low-Dose Finasteride: A Pharmacovigilance Study. Pharmacotherapy. 2015;35(7):687-695. doi:10.1002/phar.1612 | PubMed

Altomare G, Capella GL. Depression circumstantially related to the administration of finasteride for androgenetic alopecia. J Dermatol. 2002;29(10):665–669. doi:10.1111/j.1346-8138.2002.tb00200.x | PubMed

Baldessarini RJ, Pompili M. Further Studies of Effects of Finasteride on Mood and Suicidal Risk. J Clin Psychopharmacol. 2021 Nov-Dec 01. doi:10.1097/jcp.0000000000001485 | PubMed

Deng T, Duan X, He Z, Zhao Z, Zeng G. Association Between 5-Alpha Reductase Inhibitor Use and The Risk of Depression: A Meta-Analysis. Urol J. 2020;10.22037/uj.v16i7.5866. doi:10.22037/uj.v16i7.5866 | PubMed

Dyson TE, Cantrell MA, Lund BC. Lack of Association Between 5α-Reductase Inhibitors and Depression. J Urol. 2020;101097JU0000000000001079. doi:10.1097/JU.0000000000001079 | PubMed

Hagberg KW, Divan HA, Nickel JC, Jick SS. Risk of Incident Antidepressant-Treated Depression Associated with Use of 5α-Reductase Inhibitors Compared with Use of α-Blockers in Men with Benign Prostatic Hyperplasia: A Population-Based Study Using the Clinical Practice Research Datalink. Pharmacotherapy. 2017;37(5):517‐527. doi:10.1002/phar.1925 | PubMed

Irwig MS. Depressive symptoms and suicidal thoughts among former users of finasteride with persistent sexual side effects. J Clin Psychiatry. 2012;73(9):1220-1223. doi:10.4088/JCP.12m07887

Irwig MS. Finasteride and Suicide: A Postmarketing Case Series. Dermatology. 2020:1-6. doi:10.1159/000505151 | PubMed

Kim JA, Choi D, Choi S, Chang J, Park SM. The Association of 5α-Reductase Inhibitor With Suicidality. Psychosom Med. 2020 Apr;82(3):331-336. doi:10.1097/PSY.0000000000000784 | PubMed

Kim JH, Shim SR, Khandwala Y, Del Giudice F, Sorensen S, Chung BI. Risk of Depression after 5 Alpha Reductase Inhibitor Medication: Meta-Analysis. World J Mens Health. 2020 Oct;38(4):535-544. doi:10.5534/wjmh.190046 | PubMed

Melcangi RC, Caruso D, Abbiati F, et al. Neuroactive steroid levels are modified in cerebrospinal fluid and plasma of post-finasteride patients showing persistent sexual side effects and anxious/depressive symptomatology. J Sex Med. 2013;10(10):2598-2603. doi:10.1111/jsm.12269 | PubMed

Muderrisoglu AE, Becher KF, Madersbacher S, Michel MC. Cognitive and mood side effects of lower urinary tract medication. Expert Opin Drug Saf. 2019 Oct;18(10):915-923. doi:10.1080/14740338.2019.1652269 | PubMed

Nguyen DD, Marchese M, Cone EB, et al. Investigation of Suicidality and Psychological Adverse Events in Patients Treated With Finasteride. JAMA Dermatol. 2020 Nov 11. doi:10.1001/jamadermatol.2020.3385 | PubMed

Pompili M, Magistri C, Maddalena S, Mellini C, Persechino S, Baldessarini RJ. Risk of Depression Associated With Finasteride Treatment. J Clin Psychopharmacol. 2021 Mar 31. doi:10.1097/JCP.0000000000001379 | PubMed

Rahimi-Ardabili B, Pourandarjani R, Habibollahi P, Mualeki A. Finasteride induced depression: a prospective study. BMC Clin Pharmacol. 2006;6:7. doi:10.1186/1472-6904-6-7 | PubMed

Römer B, Gass P. Finasteride-induced depression: new insights into possible pathomechanisms [published correction appears in J Cosmet Dermatol. 2011 Mar;10(1):85]. J Cosmet Dermatol. 2010;9(4):331-332. doi:10.1111/j.1473-2165.2010.00533.x | PubMed

Saengmearnuparp T, Lojanapiwat B, Chattipakorn N, Chattipakorn S. The connection of 5-alpha reductase inhibitors to the development of depression. Biomed Pharmacother. 2021 Aug 31;143:112100. doi:10.1016/j.biopha.2021.112100 | PubMed | Full text

Schmutz JL. Dépression et idées suicidaires avec le finastéride [Depression and suicidal thoughts associated with finasteride]. Ann Dermatol Venereol. 2018;145(2):155–156. doi:10.1016/j.annder.2018.01.006 | PubMed

Singh MK, Avram M. Persistent sexual dysfunction and depression in finasteride users for male pattern hair loss: a serious concern or red herring? J Clin Aesthet Dermatol. 2014;7(12):51-55. PubMed

Traish AM, Hassani J, Guay AT, Zitzmann M, Hansen ML. Adverse side effects of 5α-reductase inhibitors therapy: persistent diminished libido and erectile dysfunction and depression in a subset of patients. J Sex Med. 2011;8(3):872-884. doi:10.1111/j.1743-6109.2010.02157.x | PubMed

Traish AM, Mulgaonkar A, Giordano N. The dark side of 5α-reductase inhibitors’ therapy: sexual dysfunction, high Gleason grade prostate cancer and depression. Korean J Urol. 2014;55(6):367-379. doi:10.4111/kju.2014.55.6.367 | PubMed

Welk B, McArthur E, Ordon M, Anderson KK, Hayward J, Dixon S. Association of Suicidality and Depression With 5α-Reductase Inhibitors. JAMA Intern Med. 2017;177(5):683–691. doi:10.1001/jamainternmed.2017.0089 | PubMed

Animal studies

Sasibhushana RB, Shankaranarayana Rao BS, Srikumar BN. Repeated finasteride administration induces depression-like behavior in adult male rats. Behav Brain Res. 2019;365:185–189. doi:10.1016/j.bbr.2019.03.006 | PubMed

Ocular & dental

Ocular toxicity

General

Fraunfelder, F. Chapter 7: Hormones and Drugs Affecting Hormonal Mechanisms. Drug-Induced Ocular Side Effects. 8th Edition. Elsevier; 2020.

Nguyen LH, Makino A, Namkoong P, Yiannakou Y, Narain K. Finasteride Induced Clinical Ocular Toxicity (ARVO Annual Meeting Abstract). Investigative Ophthalmology & Visual Science [Not indexed in PubMed]. 2018 Jul;59(9):2655. Abstract | Poster | Summary on South Bay Retina website | A letter regarding finasteride

Cataract

Chou SY, Kao SC, Hsu WM. Propecia-associated bilateral cataract. Clin Exp Ophthalmol. 2004 Feb;32(1):106-8. doi:10.1046/j.1442-9071.2004.00770.x | PubMed

Dry eye / meibomian gland dysfunction

Krenzer KL, Dana MR, Ullman MD, et al. Effect of androgen deficiency on the human meibomian gland and ocular surface. J Clin Endocrinol Metab. 2000 Dec;85(12):4874-82. doi:10.1210/jcem.85.12.7072 | PubMed

Li K, Zhang C, Yang Z, Wang Y, Si H. Evaluation of a novel dry eye model induced by oral administration of finasteride. Mol Med Rep. 2017;16(6):8763–8770. doi:10.3892/mmr.2017.7754 | PubMed

Nguyen BJ, Meer E, Gupta AS, et al. The effect of finasteride on dry eye disease. Paper presented at: ARVO 2022: Annual Meeting of the Association for Research in Vision and Ophthalmology; May 1, 2022; Denver, CO. Abstract (PDF)

Singh S, Moksha L, Sharma N, Titiyal JS, Biswas NR, Velpandian T. Development and evaluation of animal models for sex steroid deficient dry eye. J Pharmacol Toxicol Methods. 2014;70(1):29–34. doi:10.1016/j.vascn.2014.03.004 | PubMed

Zhang C, Li K, Yang Z, Wang Y, Si H. The Effect of the Aqueous Extract of Bidens Pilosa L. on Androgen Deficiency Dry Eye in Rats. Cell Physiol Biochem. 2016;39(1):266-77. doi:10.1159/000445622 | PubMed

Intraoperative Floppy Iris Syndrome

Chatziralli IP, Peponis V, Parikakis E, Maniatea A, Patsea E, Mitropoulos P. Risk factors for intraoperative floppy iris syndrome: a prospective study. Eye (Lond). 2016 Aug;30(8):1039-44. doi:10.1038/eye.2016.122 | PubMed | PMC full text

Chatziralli IP, Sergentanis TN, Papazisis L, Moschos MM. Risk factors for intraoperative floppy iris syndrome: a retrospective study. Acta Ophthalmol. 2012 Mar;90(2):e152-3. doi:10.1111/j.1755-3768.2011.02132.x | PubMed

Horvath K, Vultur F, Simon V, Voidazan S, Mühlfay G. Research on intraoperative iris behavior in rabbits treated with tamsulosin and finasteride. Hippokratia. 2015 Jan-Mar;19(1):20-4. PubMed | PMC full text

Issa SA, Dagres E. Intraoperative floppy iris syndrome and finasteride intake. J Cataract Refect Surg. 2007;33:2142– 2143. doi:10.1016/j.jcrs.2007.07.025 | PubMed

Kaczmarek IA, Prost ME, Wasyluk J. Clinical risk factors associated with intraoperative floppy iris syndrome: a prospective study. Int Ophthalmol. 2019;39(3):541‐549. doi:10.1007/s10792-018-0840-3 | PubMed

Wong AC, Mak ST. Finasteride-associated cataract and intraoperative floppy-iris syndrome. J Cataract Refract Surg. 2011 Jul;37(7):1351-4. doi:10.1016/j.jcrs.2011.04.013 | PubMed

Yeu E, Grostern R. Saw palmetto and intraoperative floppy-iris syndrome. J Cataract Refract Surg. 2007 May;33(5):927-8. doi:10.1016/j.jcrs.2006.12.032 | PubMed

Macular conditions

Lombardo, R., Loraschi, A., Lecchini, S, Cosentino, M. Finasteride-Associated Central Serious Chorioretinopathy. Drug Safety. 2008;31:885. doi:10.2165/00002018-200831100-00098

Shin YK, Lee GW, Kang SW, Kim SJ, Kim AY. Macular Abnormalities Associated With 5α-Reductase Inhibitor. JAMA Ophthalmol. 2020 Jul 1;138(7):732-739. doi:10.1001/jamaophthalmol.2020.1279 | PubMed

[Letter] Burgos-Blasco B, Burgos-Blasco P. Macular Abnormalities Associated With 5α-Reductase Inhibitor. JAMA Ophthalmol. 2021 Feb 1;139(2):251-252. doi:10.1001/jamaophthalmol.2020.5768 | PubMed

[Reply] Shin YK, Kang SW. Macular Abnormalities Associated With 5α-Reductase Inhibitor-Reply. JAMA Ophthalmol. 2021 Feb 1;139(2):252-253. doi:10.1001/jamaophthalmol.2020.5774 | PubMed

Dental adverse effects

Paunica S, Giurgiu M, Vasilache A, et al. Finasteride adverse effects and post-finasteride syndrome; implications for dentists. Journal of Mind and Medical Sciences. 2016;3(1):71-79. https://scholar.valpo.edu/jmms/vol3/iss1/9/. Accessed May 14, 2021.

Hepatic, metabolic & renal function

Liver & metabolism

Alkahtane AA, Albasher G, Al-Sultan NK, et al. Long-term treatment with finasteride induces apoptosis and pathological changes in female mice. Hum Exp Toxicol. 2019. doi:10.1177/0960327119842195 • PubMed

da Cruz GK, Martins MIM, Antunes FTT, et al. Evaluation of the efficacy and toxicity of oral and topical pumpkin oil on the hair growth of mice. Acta Histochem. 2022 Apr 18;124(4):151894. doi:10.1016/j.acthis.2022.151894 • PubMed [Includes finasteride treatment group]

Hazlehurst JM, Oprescu AI, Nikolaou N, et al. Dual-5α-Reductase Inhibition Promotes Hepatic Lipid Accumulation in Man. J Clin Endocrinol Metab. 2016 Jan;101(1):103-13. doi:10.1210/jc.2015-2928 | PubMed | PMC full text

Johnstone J, Lusty A, Tohidi M, et al. The association of new-onset diabetes mellitus and medical therapy for benign prostatic hyperplasia: A population-based study. Can Urol Assoc J. 2021 Aug;15(8):240-246. doi:10.5489/cuaj.7489 | PubMed | PMC full text

Livingstone DE, Barat P, Di Rollo EM, et al. 5α-Reductase type 1 deficiency or inhibition predisposes to insulin resistance, hepatic steatosis, and liver fibrosis in rodents. Diabetes. 2015;64(2):447-458. doi:10.2337/db14-0249 | PubMed

Nasiri M, Nikolaou N, Parajes S, et al. 5α-Reductase Type 2 Regulates Glucocorticoid Action and Metabolic Phenotype in Human Hepatocytes. Endocrinology. 2015;156(8):2863-2871. doi:10.1210/en.2015-1149 | PubMed

Traish AM. Health Risks Associated with Long-Term Finasteride and Dutasteride Use: It’s Time to Sound the Alarm. World J Mens Health. 2020 Jul;38(3):323-337. doi:10.5534/wjmh.200012 | PubMed | PMC full text

Kidneys & renal function

Baig MS, Kolasa-Wołosiuk A, Pilutin A, et al. Finasteride-Induced Inhibition of 5α-Reductase Type 2 Could Lead to Kidney Damage-Animal, Experimental Study. Int J Environ Res Public Health. 2019;16(10):E1726. doi:10.3390/ijerph16101726 | PubMed

Da Silva MHA, Estrada JHD, Gregório BM, Sampaio FJB, De Souza DB. Does treatment with dutasteride or finasteride has [sic] impact on renal morphology? Experimental study. Acta Cir Bras. 2021;36(7):e360703. doi:10.1590/ACB360703 | PubMed

Tian H, Zhao C, Wu H, et al. Finasteride reduces microvessel density and expression of vascular endothelial growth factor in renal tissue of diabetic rats. Am J Med Sci. 2015;349(6):516-520. doi:10.1097/MAJ.0000000000000451 | PubMed

Endocrine system

Gynecomastia

Case reports on PubMed: Run search

Ferrando J, Grimalt R, Alsina M, Bulla F, Manasievska E. Unilateral gynecomastia induced by treatment with 1 mg of oral finasteride. Arch Dermatol. 2002;138(4):543‐544. doi:10.1001/archderm.138.4.543 | PubMed

Green L, Wysowski DK, Fourcroy JL. Gynecomastia and breast cancer during finasteride therapy. N Engl J Med. 1996 Sep 12;335(11):823. doi:10.1056/NEJM199609123351116 | PubMed

Hagberg KW, Divan HA, Fang SC, Nickel JC, Jick SS. Risk of gynecomastia and breast cancer associated with the use of 5-alpha reductase inhibitors for benign prostatic hyperplasia. Clin Epidemiol. 2017;9:83‐91. doi:10.2147/CLEP.S124674 | PubMed

Lee SG, Park PJ, Lee SR, et al. Influence of Postoperative Finasteride Therapy on Recurrence of Gynecomastia After Mastectomy in Men Taking Finasteride for Alopecia. Am J Mens Health. 2019 Sep-Oct;13(5):1557988319871423. doi:10.1177/1557988319871423 | PubMed

Ramot Y, Czarnowicki T, Zlotogorski A. Finasteride induced Gynecomastia: Case report and Review of the Literature. Int J Trichology. 2009;1(1):27–29. doi:10.4103/0974-7753.51930 | PubMed

Schmutz JL, Barbaud A, Trechot P. Gynécomastie et finastéride (Propecia): 4 nouveaux cas [Finasteride (Propecia) and gynecomastia: 4 new cases]. Ann Dermatol Venereol. 2004 Jun-Jul;131(6-7 Pt 1):615. French. doi:10.1016/s0151-9638(04)93684-8 | PubMed

Genome

DNA damage

Albasher G, Bin-Jumah M, Alfarraj S, et al. Prolonged use of finasteride—induced gonadal sex steroids alterations, DNA damage and menstrual bleeding in women. Biosci Rep. 2020. doi:10.1042/BSR20191434 • PubMed • PMC full text

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

Special topic

Adverse effects in women

Albasher G, Bin-Jumah M, Alfarraj S, et al. Prolonged use of finasteride-induced gonadal sex steroids alterations, DNA damage and menstrual bleeding in women. Biosci Rep. 2020;40(2):BSR20191434. doi:10.1042/BSR20191434| PubMed

Fiuk J, Butcher M, Kohler T, McVary K. 133 Female Post-Finasteride Syndrome: It’s Not Just A Man’s World. Journal Sex Med. 2016 May 1;13(5, suppl 1):S62-S63. doi:10.1016/j.jsxm.2016.02.139

Frye CA. Inhibition of 5alpha-reductase enzyme or GABA(A) receptors in the VMH and the VTA attenuates progesterone-induced sexual behavior in rats and hamsters. J Endocrinol Invest. 2001 Jun;24(6):399-407. PubMed

Iamsumang W, Leerunyakul K, Suchonwanit P. Finasteride and Its Potential for the Treatment of Female Pattern Hair Loss: Evidence to Date. Drug Des Devel Ther. 2020 Mar 2;14:951-959. doi:10.2147/DDDT.S240615 | PubMed

Lee SW, Juhasz M, Mobasher P, Ekelem C, Mesinkovska NA. A Systematic Review of Topical Finasteride in the Treatment of Androgenetic Alopecia in Men and Women. J Drugs Dermatol. 2018;17(4):457–463. Journal site | PubMed

Mervis JS, Borda LJ, Miteva M. “Post-finasteride syndrome”: what to tell our female patients? Br J Dermatol. 2018;179(3):785-786. doi:10.1111/bjd.16658 | PubMed

Seale LR, Eglini AN, McMichael AJ. Side Effects Related to 5 α-Reductase Inhibitor Treatment of Hair Loss in Women: A Review. J Drugs Dermatol. 2016;15(4):414-419. Journal site | PubMed

Soares Júnior JM, Guimarães DZ, Simões RDS, et al. Systematic review of finasteride effect in women with hirsutism. Rev Assoc Med Bras (1992). 2021 Jul;67(7):1043-1049. doi:10.1590/1806-9282.20210248 | PubMed

Suchonwanit P, Iamsumang W, Leerunyakul K. Topical finasteride for the treatment of male androgenetic alopecia and female pattern hair loss: a review of the current literature. J Dermatolog Treat. 2020;1-21. doi:10.1080/09546634.2020.1782324 | PubMed

Teichert M, van Puijenbroek E, Stricker BH. Contraindicated use of 5-alpha-reductase inhibitors in women. Br J Clin Pharmacol. 2017;83(2):429-431. doi:10.1111/bcp.13118 | 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;7(50):82074-82084. doi:10.18632/oncotarget.12617 | PubMed

Animal studies

Alkahtane AA, Albasher G, Al-Sultan NK, et al. Long-term treatment with finasteride induces apoptosis and pathological changes in female mice. Hum Exp Toxicol. 2019;38(7):762-774. doi:10.1177/0960327119842195 | PubMed

Cumberland AL, Palliser HK, Crombie GK, Walker DW, Hirst JJ. Increased anxiety-like phenotype in female guinea pigs following reduced neurosteroid exposure in utero. Int J Dev Neurosci. 2017;58:50–58. doi:10.1016/j.ijdevneu.2017.02.001 | PubMed

Erskine MS. Effects of an anti-androgen and 5 alpha-reductase inhibitors on estrus duration in the cycling female rat. Physiol Behav. 1983;30(4):519-524. doi:10.1016/0031-9384(83)90214-7 | PubMed

Maldarine JS, Sanches BDA, Santos VA, et al. Postnatal exposure to finasteride causes different effects on the prostate of male and female gerbils. Cell Biol Int. 2020 Jun;44(6):1341-1352. doi:10.1002/cbin.11328 | PubMed