Finasteride side effects are often discussed in the doctor’s office in the context of treating male-pattern (androgenic) hair loss. Many men fear that finasteride will significantly affect their daily functioning. But do you have to choose between healthy hair and a successful sex life? According to studies, finasteride side effects occur in about 3 percent of men treated. And the intensity of side effects varies, from barely noticeable to making everyday life difficult. Looking at this data from a different perspective, we can say that as many as 97% of men treated with finasteride do not experience any side effects.
The most common finasteride side effects
1. Libido
Reduced libido, or a lower desire for sex and erectile dysfunction. Reduced libido can be caused by many factors, not just the use of finasteride. Taking the drug can overlap with other factors that will cause similar symptoms. Here are the most important reasons that affect the decrease in sexual drive:
Pharmacological factors (drugs)
- Finasteride and dutasteride – drugs used for androgenetic alopecia and prostate enlargement may cause decreased libido and erectile dysfunction.
- Antidepressants (SSRI, SNRI) – e.g. fluoxetine, sertraline, paroxetine may decrease libido and cause anorgasmia.
- Beta-blockers – used for hypertension, may cause decreased libido and weakened erections.
- Antipsychotic medications – e.g. olanzapine, risperidone, may lower dopamine levels, which affects sexual drive.
- Opioids (e.g. tramadol, morphine) – long-term use may reduce testosterone production.
- Anabolic steroids – overuse can lead to suppression of natural testosterone production.
Hormonal disorders
- Low testosterone levels – the main hormone responsible for libido; its decline may be caused by aging, thyroid disease, excess estrogen or stress.
- Increased prolactin levels – e.g. as a result of a pituitary tumor (prolactinoma), use of certain medications (e.g. metoclopramide).
- Thyroid disorders – Both hypothyroidism and hyperthyroidism can cause decreased libido.
- Insulin resistance and diabetes – can lead to hormonal disruptions and neuropathy that impair sexual function.
Psychological and emotional factors
- Stress and fatigue – excess cortisol can inhibit testosterone production.
- Depression and anxiety – often cause loss of interest in sex.
- Relationship problems – conflicts, lack of emotional connection, infidelity can lower libido.
Lifestyle
- Lack of physical activity – a sedentary lifestyle lowers testosterone levels.
- Poor diet – deficiencies of zinc, vitamin D, magnesium can negatively affect libido.
- Alcohol and drug abuse – Alcohol lowers testosterone levels and marijuana can affect dopamine receptors.
- Sleep deprivation – reduces the production of hormones responsible for libido.
Chronic diseases
- Cardiovascular disease – poor circulation affects erection and libido.
- Chronic renal and hepatic failure – metabolic disorders can affect hormone production.
- Chronic fatigue syndrome (CFS) and fibromyalgia – often associated with decreased libido.
2. Testicular pain
Testicular pain or tenderness. A very small number of men experience pressure in one or both testicles during the first few days of taking finasteride. If this feeling does not subside after 3-4 days, the drug should be discontinued. However, it is important to remember that there may be other causes of testicular pain.
Drugs and substances that affect hormones
- Finasteride and dutasteride – may cause testicular tenderness due to changes in dihydrotestosterone (DHT) levels, which may affect testicular function.
- Anabolic steroids – may cause testicular atrophy and pain due to sudden changes in testosterone levels.
- Anticancer drugs (e.g. chemotherapy) – may cause testicular tissue damage and tenderness.
- Hormonal medications (e.g. anti-androgen therapy for prostate cancer) – may affect testicular function.
Hormonal disorders
- Testosterone deficiency – may cause pain and decreased testicular volume.
- High levels of estrogen or prolactin – can cause swelling and tenderness of the testicles.
- Thyroid disorders – may affect the metabolism of sex hormones.
Infections and inflammations
- Inflammation of the epididymis (epididymitis) – a bacterial infection (often caused by chlamydia or gonorrhea) causes severe pain and swelling.
- Inflammation of the testicle (orchitis) – often related to the mumps virus, but can also be bacterial.
- Urinary tract or prostate infections – may cause pain that radiates to the testicles.
Vascular and neurological problems
- Testicular torsion – sudden, severe pain requiring immediate surgical intervention.
- Varicocele – can cause feelings of heaviness and discomfort.
- Neuralgia and neuropathy – e.g. after pelvic surgery, may cause chronic testicular pain.
Mechanical and traumatic factors
- Testicular trauma – impact or pressure may cause pain.
- Too tight underwear or sitting for too long can cause discomfort and slight tenderness.
- Inguinal hernia – may cause pain radiating to the testicle.
Psychological factors
- Stress and nervous tension – can cause psychosomatic pain in the testicular area.
- Psychosomatic disorders (e.g. hypochondria associated with finasteride) – may lead to excessive concentration on that part of the body and pain sensation.
When should you start to worry? If the pain is:
- Sudden and very severe → it may be testicular torsion – requires urgent medical intervention.
- Persisting for a longer period of time → it is worth consulting a urologist.
- It is accompanied by swelling, redness, fever → it may be an infection that requires antibiotic therapy.
- Mild but chronic, without other symptoms → may be due to medication (e.g. finasteride) or vascular problems.
3. Well-being
Worse well-being, fatigue or depression and anxiety. Because the drug affects the level of the active form of testosterone, it can cause symptoms characteristic of a deficiency of the male hormone. Such side effects of finesteride are most often revealed in people with low levels of testosterone in the blood before treatment. In such a case, a testosterone level test should be performed and hormone supplementation should be considered under the supervision of an endocrinologist or andrologist.
Androgenic alopecia can occur in people with low testosterone levels, because the sensitivity of hair follicles to dihydrotestosterone is decisive, not the level of testosterone itself. There are people with naturally high levels of testosterone who do not experience baldness.
Testosterone plays a key role not only in physical function but also in mental health. Studies suggest that low testosterone levels may be linked to depression, fatigue, low mood, and apathy. In turn, depression can negatively impact testosterone levels, creating a vicious cycle.
How does low testosterone affect depression?
- Reduced production of dopamine and serotonin – Testosterone affects the levels of these neurotransmitters that regulate mood. Low levels can lead to decreased motivation, energy, and joy of life.
- Fatigue and lack of energy – People with low testosterone often complain of chronic fatigue and lack of energy, which can lead to depression.
- Sleep disorders – Testosterone regulates the circadian rhythm. Its deficiency can cause problems with falling asleep and the quality of sleep, which worsens the symptoms of depression.
- Decreased libido and satisfaction with sexual life – Lack of sexual drive and erection problems can lower self-esteem and lead to depression.
- Increased cortisol (stress hormone) levels – High cortisol levels lower testosterone production, which can lead to increased levels of anxiety and depression.
Can depression lower testosterone? Yes, depression itself can lead to lower testosterone levels by:
- Excessive stress and elevated cortisol levels
- Lack of physical activity
- Reduced motivation to maintain a healthy lifestyle
- Sleep disorders that affect testosterone production
What symptoms indicate low testosterone and depression?
Symptoms of low testosterone: decreased libido, lack of energy and chronic fatigue, loss of muscle mass and increase in body fat, sleep problems, lack of motivation and joy of life.
Symptoms of depression: sadness, apathy, lack of motivation, sleep disturbances (insomnia or hypersomnia), lack of interest in things that previously brought joy, anxiety and a sense of hopelessness, problems with concentration.
How to increase testosterone levels and improve mood?
Natural ways to increase testosterone:
- A diet rich in healthy fats (avocado, olive oil, eggs, nuts)
- Physical activity – especially strength training and interval training (HIIT)
- Vitamin D and zinc – crucial for testosterone production
- Reducing stress – meditation, breathing techniques
- Getting enough sleep – at least 7-8 hours of sleep
- Avoiding alcohol and processed foods
Hormone replacement therapy (TRT) – if your testosterone levels are very low, your doctor may recommend hormone replacement therapy.
4. Fertility
Finasteride and fertility. It is a drug used mainly in the treatment of androgenetic alopecia (1 mg) and benign prostatic hyperplasia (5 mg). Its action is based on blocking the enzyme 5α-reductase, which converts testosterone into its stronger form – dihydrotestosterone (DHT). In the case of the treatment of prostate hyperplasia, the drug is used chronically for a dozen or even several dozen years at a dose five times higher than in the case of the treatment of androgenetic alopecia. A dose of 1 mg is sufficient to stop baldness.
How does finasteride affect fertility?
- Reduced sperm count – Studies have shown that in some men taking finasteride, sperm count may be reduced by as much as 25-30%.
- Decreased semen volume – Finasteride can affect the prostate gland and seminal vesicles, which are responsible for producing seminal fluid. Decreased prostate volume can lead to a smaller amount of semen.
- Decreased sperm motility – sperm may move slower, reducing their ability to fertilize an egg.
- Sperm morphology abnormalities – Some studies suggest that finasteride may cause a higher percentage of abnormal sperm.
- Reduced libido – although it does not directly affect sperm quality, it may make trying for a baby more difficult.
Are the effects of finasteride permanent?
The good news is that most men’s sperm counts return to normal after discontinuing the drug. Studies show that sperm counts return to normal within 3 months of discontinuing finasteride. After 6 to 12 months, all sperm counts usually improve.
So does finasteride cause infertility?
It cannot be unequivocally stated that finasteride causes permanent infertility. Most studies indicate that its effect is reversible, but in some men it can significantly reduce the chances of conception while taking the drug. Therefore, it is recommended to stop finasteride therapy 3 months before planned conception. There is no evidence that finasteride damages sperm DNA or causes genetic defects in children.
However, it is not recommended to give the drug to pregnant women while taking finasteride, because it can affect the development of a male fetus. If a man takes finasteride while his partner is pregnant, a condom should be used during intercourse. Finasteride or its metabolites may be present in semen, which can affect the development of a male fetus.
Summary
Finasteride is a safe and commonly used drug. It does not cause side effects in most men, but a small group of patients may experience them. If the side effects of finasteride clearly interfere with everyday functioning, it is best to discontinue the drug and consider alternative treatment with a dermatologist or trichologist. After discontinuing the drug, the side effects should disappear within 14 to 21 days.
It is recommended to perform testosterone level tests to check if it is not too low and whether it is not necessary to implement male hormone supplementation. This can significantly improve the quality of life – add energy, motivation and improve mood. Increasingly, psychiatrists order testosterone level tests because it is a fairly common cause of depression in men.
Today, there are alternative treatments available to help reduce the side effects of finasteride and other DHT blockers. Applying the drug locally, in the form of a liquid to the scalp, helps reduce the effects of finasteride on the entire body. Similar benefits are shown by mesotherapy of the scalp with dutasteride, a strong dihydrotestosterone blocker.
Need medical advice on treating baldness? Book an appointment by phone at +48 579645819 or online.
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