Male-pattern hair loss, also known as androgenetic alopecia, will affect up to 80% of men by the time they reach the age of 70. Male-pattern hair loss is genetic and results in shrinking hair follicles, making hair harder to grow.
Propecia, or finasteride as it’s known generically, is a common treatment for male-pattern hair loss. Finasteride works by reducing the body's production of dihydrotestosterone (DHT), a hormone that contributes to hair loss. However, this drug has been associated with low sex drive (libido) and ejaculatory disorders. Many studies focus on the 5 mg dose for benign prostatic hyperplasia (BPH), or an enlarged prostate, rather than the 1 mg dose used for hair loss.
Recently, researchers studied the 1 mg dose and its possible sexual side effects. The study focused on erectile dysfunction (ED), which is difficulty getting or keeping an erection. The researchers also examined low libido and ejaculatory dysfunction, which includes premature, delayed, or painful ejaculation.
Overall, medical records from 11,666 men aged 18 to 50 were examined. Half had received 1 mg finasteride, while the other half had not. The groups were matched based on age and several health factors. None had a documented history of ED. To identify new cases of ED, researchers used medical diagnosis codes and prescriptions for phosphodiesterase type 5 inhibitors (PDE5-i).
Sexual Side Effects Linked to Long-Term Use
After one year, men taking finasteride were more likely to receive a prescription for an ED medication (1.30% vs. 0.91%). However, when researchers combined prescriptions and ED diagnoses, the difference was not significant (1.53% vs. 1.26%).
After three years, the differences were a bit more pronounced. Men taking finasteride had higher rates of ED (4.05% vs. 2.78%), low libido (1.07% vs. 0.66%), and ejaculatory dysfunction (0.59% vs. 0.30%). The overall rates of sexual problems remained relatively low.
What This Means for Men Taking Finasteride
While this suggests a possible link between finasteride and sexual dysfunction, the study cannot prove that the medication caused these problems. More research is needed to understand the risks of this specific medication.
Key Takeaways
- Finasteride is a common treatment for male-pattern hair loss, prescribed at a lower 1 mg dose than the 5 mg prostate treatment.
- Sexual side effects, including ED, low libido, and ejaculatory disorders, have been associated with this medication.
- After three years, men taking 1 mg finasteride had higher recorded rates of ED, low libido, and ejaculatory dysfunction than men who were not prescribed the medication.
- More research is needed to understand these risks.
- Men who experience ED, low libido, or ejaculatory dysfunction while taking finasteride should speak with their healthcare provider about their symptoms and treatment options.
Resources
Bhambhvani, H. P., Greenberg, D. R., Drian, A., Panken, E. J., Peterson, D. J., Kuchakulla, M., Farhangui, A., Halpern, J. A., & Kashanian, J. A. (2026). Risk of sexual dysfunction among reproductive-aged men following low-dose finasteride for androgenetic alopecia: A propensity-matched cohort study. The Journal of Sexual Medicine, 23(10), Article qdag313. Oxford Academic. https://doi.org/10.1093/jsxmed/qdag313
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