Research by symptom / clinical presentation

Eye conditions
Gynecomastia
Persistent adverse effects & ‘post-finasteride syndrome’
Semen, sperm and fertility
Sexual function
Suicide, suicidality, depression and other psychological adverse events

Special topic

Adverse effects on women

Eye conditions

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

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

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

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

Animal studies

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

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

Gynecomastia

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

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, Koo BH, Byun GY, Kim MJ, Kang HJ, Kim S, Oh BS, Lee YH. 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

Persistent adverse effects & ‘post-finasteride syndrome’

See Bibliography: Persistent adverse effects & ‘post-finasteride syndrome’

Semen, sperm and fertility

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

Birch MR, Dissing S, Skakkebæk NE, Rehfeld A. Finasteride interferes with prostaglandin-induced CatSper-signalling in human sperm. Reproduction. 2021 Mar 1:REP-20-0287.R3. doi:10.1530/REP-20-0287 | 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

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

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

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

Overstreet JW, Fuh VL, Gould J, Howards SS, Lieber MM, Hellstrom W, Shapiro S, Carroll P, Corfman RS, Petrou S, Lewis R, Toth P, Shown T, Roy J, Jarow JP, Bonilla J, Jacobsen CA, Wang DZ, Kaufman KD. Chronic treatment with finasteride daily does not affect spermatogenesis or semen production in young men. J Urol. 1999 Oct;162(4):1295-300 | PubMed

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

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

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

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

Cukierski MA, Sina JL, Prahalada S, Wise LD, Antonello JM, MacDonald JS, Robertson RT. 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

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

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

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

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

Wise LD, Minsker DH, Cukierski MA, Clark RL, Prahalada S, Antonello JM, MacDonald JS, Robertson RT. 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 function

This list excludes 1) papers on older men taking finasteride for prostate conditions such as BPH; and 2) papers on persistent adverse effects of finasteride, including sexual adverse effects. The bibliography on persistent adverse effects is here.

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

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

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

Finasteride 1 mg in alopecia: sexual dysfunction, suicidal ideation. Prescrire Int. 2016;25(175):242. Journal site

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

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

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

Pallotti F, Senofonte G, Pelloni M, Cargnelutti F, Carlini T, Radicioni AF, Rossi A, Lenzi A, Paoli D, Lombardo F. 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

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

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

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

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;82(3):743.e9–743.e7.43E15. doi:10.1016/j.urology.2013.02.045 | PubMed

Suicide, suicidality, depression & psychological 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

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

Nguyen DD, Marchese M, Cone EB, Paciotti M, Basaria S, Bhojani N, Trinh QD. 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

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

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

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

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

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

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

Special topic: Adverse effects on 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

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

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

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

Maldarine JS, Sanches BDA, Santos VA, Cabral ÁS, Lima MLD, Bedolo CM, Calmon MF, Rahal P, Góes RM, Vilamaior PSL, Taboga SR. 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

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