Finasteride, known as Propecia or Proscar, is a medication primarily prescribed to men for male pattern baldness (androgenetic alopecia) and benign prostatic hyperplasia (BPH), an enlargement of the prostate gland. It functions as a 5-alpha reductase inhibitor, reducing the body’s production of dihydrotestosterone (DHT), a hormone contributing to hair loss and prostate growth. Its effects are relevant for individuals considering conception, as it can influence male fertility and pose risks during pregnancy.
How Finasteride Can Affect Male Fertility
Finasteride’s action of lowering DHT levels can affect male reproductive function. While not all men experience fertility issues, finasteride use may lead to changes in semen parameters, including reduced semen volume and sperm count. Some research shows a decrease in sperm concentration and volume by over 21% in some users.
The exact mechanism by which DHT reduction affects spermatogenesis, the process of sperm production, is still being researched. However, the effects on fertility are often reversible once the medication is discontinued. Studies show significant increases in sperm count after stopping finasteride, with some reporting an average 11.6-fold increase. Recovery can be noticeable within a few months, with improvements seen as early as 10 weeks and significant recovery within six months for severe oligospermia or azoospermia. Finasteride is not known to cause permanent infertility.
Understanding Pregnancy Risks with Finasteride
Finasteride poses significant risks during pregnancy, particularly for a male fetus, and is classified as a Category X drug due to its teratogenic potential. The drug can interfere with the normal development of external genitalia in a male fetus, potentially leading to abnormalities such as hypospadias, a condition where the urethral opening is not at the tip of the penis. This risk stems from finasteride’s anti-androgenic effects, as DHT is essential for proper male genital formation during fetal development.
Due to potential skin absorption, pregnant women or those who may become pregnant should not handle crushed or broken finasteride tablets. If accidental contact occurs, wash the affected area immediately with soap and water. While finasteride can be present in semen, the amount is typically very low. Most experts agree the risk to a pregnant partner from semen exposure is minimal, though some manufacturers advise using condoms to minimize any theoretical risk.
Planning Conception While Using Finasteride
For men planning to conceive, discontinuing finasteride is generally recommended. While no universally agreed-upon washout period exists, doctors often suggest stopping finasteride for several months to allow sperm parameters to normalize. Recommendations advise discontinuation at least three months before attempting conception, as studies indicate sperm concentrations can substantially increase within three to six months after stopping.
During this discontinuation period, consistent use of barrier contraception, such as condoms, is important if there is any chance of a female partner becoming pregnant. This helps prevent any potential exposure to the drug. Partners should also be mindful of safe handling practices, particularly avoiding contact with crushed or broken tablets, to prevent accidental exposure.
Important Conversations with Healthcare Providers
Discussing finasteride use and conception plans with a healthcare provider is a necessary step. Consulting with a doctor, urologist, or fertility specialist allows for personalized advice based on individual health history, finasteride dosage, and current fertility status.
Healthcare professionals can assess the impact of finasteride on sperm parameters through semen analysis, which monitors sperm count, motility, and morphology. This can help determine if discontinuing the medication has led to improvements.
Open dialogue also provides an opportunity to explore alternatives for managing hair loss or BPH if continuing finasteride is not advisable during the conception period. They can offer guidance on the risks and benefits associated with different approaches. Professional medical guidance is essential for making informed decisions and ensuring the well-being of both partners and any future child.