If you are taking Finasteride for hair loss and you are thinking about starting a family, you should always let your prescribing clinician know. The reason for this is very simple. Finasteride can affect your fertility, cause sexual dysfunction and could make it more difficult for your partner to conceive (1). This guide explains why your clinician may advise that you stop Finasteride treatment before trying to conceive, what the evidence means for your fertility, how to stop safely and what to expect once you come off your treatment.
Why Finasteride Matters When You Are Planning a Baby
Doctors advise stopping many medications when someone is trying for a baby or pregnant. When this happens, it is usually because:
There is not enough research to know whether a drug could have an effect on a developing foetus.
There is not enough research to demonstrate how it will affect the person who is pregnant.
There is clinical evidence to suggest that it is not safe to take because of the impact it will have on the unborn baby or pregnant person.
The medication has been shown to affect fertility.
What Finasteride does in your body
Finasteride is a type of medication known as a 5-alpha reductase inhibitor. It works by blocking a chemical called dihydrotestosterone (DHT) that causes hair follicles to get smaller and weaker, which is the primary cause of male pattern baldness. Blocking this enzyme reduces DHT levels in your bloodstream by up to 70%, helping to stop hair loss (2).
While it is an effective treatment for hair loss, your hair is not the only part of your body that will be affected by Finasteride. The same enzyme and DHT signalling are also important in reproduction.
How Finasteride can affect male fertility
The elements of the male reproductive system, such as the prostate, penis, scrotum and seminal vessels, all rely on normal DHT levels (3). When Finasteride lowers DHT levels, it can have an impact on:
Sperm count/concentration: In one study, sperm concentration in men taking 1mg Finasteride daily was 55.6 million/ML compared to 90.6 million/ML in non-users (4).
Sperm motility: Motility refers to the ability of sperm to swim and move properly. The same study also found that total motile sperm count was markedly lower in users (72.6 ± 79.8) compared to non-users (166.6 ± 182.9 million) (4).
Sperm morphology: Morphology refers to the size, shape and structure of a sperm cell. Normal sperm morphology was also lower in men taking Finasteride vs those who were not with results indicating 2.0 ± 2.7% vs 3.9 ± 4.0% (4).
Semen volume: Semen volume was lower in users of Finasteride whose levels were found to be 2.7 ± 1.5 mL compared to 3.2 ± 1.7 mL (p = 0.02) in non-users (4).
The good news is that stopping Finasteride has been shown to improve sperm count, with hormone levels and sperm quality remaining stable (5).
How Finasteride can affect sexual function
It is not just sperm production that can be affected by Finasteride. There are many studies that also show that sexual side effects of oral Finasteride include but are not limited to (6):
Decreased libido/sex drive
Erectile dysfunction
Delayed ejaculation
Difficulty reaching orgasm
A 2023 review found that men taking Finasteride 1 mg may be about 1.6 times more likely to experience sexual side effects than men taking a placebo.
However, these problems were uncommon overall, and many men found that their symptoms improved either while continuing treatment or after stopping Finasteride. Some people have reported sexual symptoms lasting after treatment has ended, but it is still uncertain how often this happens and whether Finasteride is always the cause (7).
Nevertheless, sexual side effects are still something to bear in mind when it comes to trying to conceive after taking Finasteride.
What we do and don’t know about risks to the baby if you try to conceive while taking Finasteride
What about the impact of Finasteride (taken by men for hair loss) on an unborn baby?
Current evidence shows that, in men taking 1mg of Finasteride daily, only a very small amount of the drug has been detected in semen. However, research is extremely limited and on small groups of users. As it stands, there are no controlled human studies specifically affecting birth-defect rates after paternal Finasteride use (8). However, there is a small degree of evidence that suggests that Finasteride could affect the development of male foetal genitalia if a pregnant woman is directly exposed to clinically relevant amounts (8).
It is for this reason that healthcare professionals will recommend that you stop taking Finasteride before trying to conceive.
Is topical Finasteride safer than oral when trying to conceive?
Topical finasteride is designed to act locally on the scalp while limiting how much of the drug enters your bloodstream. A phase III trial found that finasteride concentrations in the bloodstream were more than 100 times lower with the topical spray than with oral finasteride (13).
Based on this research it could be said that topical finasteride carries a lower risk of any effect of semen exposure during conception. However, this hasn't actually been tested – the trial that produced these numbers was designed to assess hair growth and general safety, not fertility, sperm quality, finasteride concentration in semen, or pregnancy. So while topical finasteride does technically result in lower whole-body exposure, there's currently no direct evidence confirming it's safer for conception or pregnancy than the oral form.
When and how to stop Finasteride before trying to conceive
If you are planning to try for a baby, your prescribing clinician will probably recommend that you stop taking Finasteride at least 3 months before having unprotected sex. This is because, although sperm is made continuously, a sperm cell takes roughly 2-3 months to develop fully. After this, it also needs time to mature and move through your reproductive system (9).
By waiting for three months, it helps to ensure that all sperm that were already in production while you were taking Finasteride have been replaced by sperm produced after your treatment stopped.
In some cases, your doctor may suggest a longer break from Finasteride before trying to conceive. What is important is to always follow the guidance provided by your prescribing clinician. They have access to your full medical history and will be able to make an informed recommendation based on your personal circumstances.
Do you need to taper?
When taken for hair loss, Finasteride can usually be stopped immediately, with no taper required. However, again we would urge you to follow the recommendation from your prescribing clinician.
Do I have to stop Finasteride if my partner is already pregnant?
Finasteride blocks the conversion of testosterone to DHT – the hormone responsible, in part, for normal development of male genitalia in the womb. Because of this, animal studies have shown that exposure to sufficiently large doses of finasteride during the period when a male fetus's sex organs are forming (roughly weeks 8 to 12 of pregnancy) can cause abnormalities (14). This is the underlying concern behind manufacturer warnings.
However, it's important to separate two different routes of exposure. The main risk manufacturers warn about relates to a pregnant woman directly handling crushed or broken finasteride tablets, not to semen exposure from a partner taking the medication. Only very small amounts of finasteride pass into semen, and current guidance states that it's very unlikely to cause any harm if a pregnant partner is exposed to it through sex (8). However, manufacturers still recommend using a condom as a precaution.
We recommend discussing how to use Finasteride during pregnancy with your clinician, who can weigh this up against your reasons for continuing treatment.
What if I accidentally took Finasteride while we were trying?
Do not panic. Whether you accidentally took finasteride while having unprotected sex, or your partner became pregnant unexpectedly while you were taking your medication, the evidence is reassuring: finasteride taken by the father is not expected to cause birth defects through semen exposure, because only very small amounts of the drug pass into semen (8). Case reports of pregnancies with documented paternal finasteride exposure (both before and during pregnancy) have generally resulted in the birth of full-term, healthy infants without reported abnormalities (15).
Nevertheless, as a precaution, do not take any further doses of finasteride until you've discussed the situation with your clinician. It's worth being prepared to tell them:
When you took finasteride (the date, relative to conception)
The dose you were taking
You may also want to let the midwife know that you were taking finasteride around the time of conception at your partner's booking-in appointment, so it's on record – not because it's expected to cause a problem, but so your partner's care team has the full picture if anything unexpected comes up later in the pregnancy.
Are their any hair loss treatments that are less risky when trying to conceive?
If you are a man with male pattern hair loss and planning a pregnancy, you do not necessarily need to stop hair loss treatment altogether. There are some hair loss therapies that do not reduce DHT or carry Finasteride’s side effects and reproductive concerns.
Topical Minoxidil is a non-hormone alternative to Finasteride that works by stimulating hair regrowth by keeping hairs in the anagen (growth) phase of the cycle for longer and encouraging larger follicle development. As a non-hormone hair loss treatment, it is generally considered to be a lower risk option than oral Finasteride (10).
Microneedling is sometimes combined with topical Minoxidil to help stimulate the scalpe and potentially improve your response to treatment. A 2025 systematic review and meta-analysis found that combining microneedling with Minoxidil improved hair count or hair diameter more than Minoxidil alone, although adverse effects were more frequent (12).
If you would like more advice about stopping Finasteride to try for a family, or you would like to see what alternative hair loss therapies are available, visit our Hair Loss Hub or start a consultation to see which treatment is suitable for you.
References
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