Skip to main content

Advertisement

SpringerLink
Log in

Androgenetic alopecia: effects of oral finasteride on hormone profile, reproduction and sexual function

  • Original Article
  • Published:
Endocrine Aims and scope Submit manuscript

Abstract

Purpose

Androgenetic Alopecia (AGA) is a common non-cicatricial alopecia. AGA treatment with finasteride was reported to have sexological side effects and its induced hormonal alterations could damage spermatogenesis. Thus, in patients affected by AGA undergoing oral therapy with Finasteride 1 mg/die, we aimed to evaluate the presence of modification in sperm parameters, hormone profile and sexual function.

Methods

We retrospectively evaluated 55 male subjects aged 18–45 years with AGA who underwent systemic therapy with Finasteride 1 mg/die. Each subject underwent semen and blood hormone analysis, IIEF15 questionnaire administration at baseline (T0) at 6 (T6) and 12 (T12) months after the beginning of therapy and 1 year after treatment discontinuation (TD).

Results

At T6 we detected a statistically significant worsening of total sperm number (232.4 ± 160.3 vs. 133.2 ± 82.0; p = 0.01 vs. T0) and abnormal forms (79.8 ± 6.0 vs. 82.7 ± 5.7; p < 0.05 vs. T0). No difference was found for all sperm parameters at T12 and T24, except for the percentage of abnormal forms (79.8 ± 6.0 vs. 82.6 ± 4.8; p < 0.05 T24 vs. T0). Testosterone levels were increased at T0 vs. T6 (22.1 ± 7.1 vs. 28.0 ± 8.0 ng/mL; p < 0.05). No significant differences of IIEF15 questionnaire were detected across the study.

Conclusions

Finasteride is associated with significant seminological and testosterone alterations, but no sexual dysfunctions were reported during treatment of these andrologically healthy subjects. Although, sperm parameters seem to return comparable to baseline after treatment discontinuation, it is advisable to perform a careful andrological evaluation before treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. F. Lolli, F. Pallotti, A. Rossi et al. Androgenetic alopecia: a review. Endocrine 57, 9–17 (2017). https://doi.org/10.1007/s12020-017-1280-y

    Article  CAS  PubMed  Google Scholar 

  2. R. Hoffmann, Steroidogenic isoenzymes in human hair and their potential role in androgenetic alopecia. Dermatology 206, 85–95 (2003). https://doi.org/10.1159/000068475

    Article  CAS  PubMed  Google Scholar 

  3. V.A. Randall, N.A. Hibberts, M.J. Thornton et al. The hair follicle: a paradoxical androgen target organ. Horm. Res. 54, 243–250 (2000). https://doi.org/10.1159/000053266

    Article  CAS  PubMed  Google Scholar 

  4. V.A. Randall, Androgens and hair growth. Dermatol. Ther. 21, 314–328 (2008). https://doi.org/10.1111/j.1529-8019.2008.00214.x

    Article  PubMed  Google Scholar 

  5. K. Wang, D.D. Fan, S. Jin et al. Differential expression of 5-alpha reductase isozymes in the prostate and its clinical implications. Asian J. Androl. 16, 274–279 (2014). https://doi.org/10.4103/1008-682X.123664

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. M.A. Said, A. Mehta, The Impact of 5α-Reductase inhibitor use for male pattern hair loss on men’s health. Curr. Urol. Rep. 19, 1–6 (2018). https://doi.org/10.1007/s11934-018-0814-z

    Article  Google Scholar 

  7. J.C. Nickel, Y. Fradet, R.C. Boake et al. Efficacy and safety of finasteride therapy for benign prostatic hyperplasia: results of a 2-year randomized controlled trial (the PROSPECT Study). CMAJ 155, 1251–1259 (1996)

    CAS  PubMed  PubMed Central  Google Scholar 

  8. L. Liu, S. Zhao, F. Li et al. Effect of 5α-Reductase inhibitors on sexual function: a meta-analysis and systematic review of randomized controlled trials. J. Sex. Med 13, 1297–1310 (2016). https://doi.org/10.1016/j.jsxm.2016.07.006

    Article  PubMed  Google Scholar 

  9. R.C. Melcangi, D. Santi, R. Spezzano et al. Neuroactive steroid levels and psychiatric and andrological features in post-finasteride patients. J. Steroid Biochem Mol. Biol. 171, 229–235 (2017). https://doi.org/10.1016/j.jsbmb.2017.04.003

    Article  CAS  PubMed  Google Scholar 

  10. J.B. Hamilton, Patterned loss of hair in man; types and incidence. Ann. N. Y Acad. Sci. 53, 708–728 (1951). https://doi.org/10.1111/j.1749-6632.1951.tb31971.x

    Article  CAS  PubMed  Google Scholar 

  11. O.T. Norwood, Male pattern baldness: classification and incidence. South Med J. 68, 1359–1365 (1975). https://doi.org/10.1097/00007611-197511000-00009

    Article  CAS  PubMed  Google Scholar 

  12. WHO. WHO Laboratory Manual for the Examination and Processing of Human Semen, 5th edn. Geneva (2010)

  13. M. Spaziani, B. Mileno, F. Rossi et al. Endocrine and metabolic evaluation of classic Klinefelter syndrome and high-grade aneuploidies of sexual chromosomes with male phenotype: are they different clinical conditions? Eur. J. Endocrinol. 178, 343–352 (2018). https://doi.org/10.1530/EJE-17-0902

    Article  CAS  PubMed  Google Scholar 

  14. A. Rossi, A. Anzalone, M.C. Fortuna et al. Multi-therapies in androgenetic alopecia: review and clinical experiences. Dermatol. Ther. 29, 424–432 (2016). https://doi.org/10.1111/dth.12390

    Article  PubMed  Google Scholar 

  15. J.M. Hirshburg, P.A. Kelsey, C.A. Therrien et al. Adverse effects and safety of 5-alpha reductase inhibitors (finasteride, dutasteride): a systematic review. J. Clin. Aesthet. Dermatol. 9, 56–62 (2016)

    PubMed  PubMed Central  Google Scholar 

  16. J.W. Overstreet, V.L. Fuh, J. Gould et al. Chronic treatment with finasteride daily does not affect spermatogenesis or semen production in young men. J. Urol. 162, 1295–1300 (1999)

    Article  CAS  Google Scholar 

  17. J.K. Amory, C. Wang, R.S. Swerdloff et al. The effect of 5alpha-reductase inhibition with dutasteride and finasteride on semen parameters and serum hormones in healthy men. J. Clin. Endocrinol. Metab. 92, 1659–1665 (2007). https://doi.org/10.1210/jc.2006-2203

    Article  CAS  PubMed  Google Scholar 

  18. S. Glina, P.A. Neves, R. Saade et al. Finasteride-associated male infertility. Rev. Hosp. Clin. Fac. Med Sao Paulo 59, 203–205 (2004). https://doi.org//S0041-87812004000400009

  19. K. Chiba, K. Yamaguchi, F. Li et al. Finasteride-associated male infertility. Fertil. Steril. 95, 1786.e9–11 (2011). https://doi.org/10.1016/j.fertnstert.2010.12.001

    Article  CAS  Google Scholar 

  20. H.Y.V. Tu, A. Zini, Finasteride-induced secondary infertility associated with sperm DNA damage. Fertil. Steril. 95, 2125.e13–4 (2011). https://doi.org/10.1016/j.fertnstert.2010.12.061

    Article  Google Scholar 

  21. A. Salvarci, O. Istanbulluoglu, Secondary infertility due to use of low-dose finasteride. Int Urol. Nephrol. 45, 83–85 (2013). https://doi.org/10.1007/s11255-012-0315-9

    Article  PubMed  Google Scholar 

  22. F. Pallotti, D. Paoli, T. Carlini et al. Varicocele and semen quality: a retrospective case–control study of 4230 patients from a single centre. J. Endocrinol. Investig. 41, 185–192 (2018). https://doi.org/10.1007/s40618-017-0713-z

    Article  CAS  Google Scholar 

  23. T. Carlini, D. Paoli, M. Pelloni et al. Sperm DNA fragmentation in Italian couples with recurrent pregnancy loss. Reprod. Biomed. Online 34, 58–65 (2017). https://doi.org/10.1016/j.rbmo.2016.09.014

    Article  PubMed  Google Scholar 

  24. M.K. Samplaski, K. Lo, E. Grober, K. Jarvi, Finasteride use in the male infertility population: effects on semen and hormone parameters. Fertil. Steril. 100, 1542–1546 (2013). https://doi.org/10.1016/j.fertnstert.2013.07.2000

    Article  CAS  PubMed  Google Scholar 

  25. M.S. Irwig, Androgen levels and semen parameters among former users of finasteride with persistent sexual adverse effects. JAMA Dermatol. 150, 1361–1363 (2014). https://doi.org/10.1001/jamadermatol.2014.1830

    Article  PubMed  Google Scholar 

  26. G. Corona, G. Tirabassi, D. Santi et al. Sexual dysfunction in subjects treated with inhibitors of 5alpha-reductase for benign prostatic hyperplasia: a comprehensive review and meta-analysis. Andrology 5, 671–678 (2017). https://doi.org/10.1111/andr.12353

    Article  CAS  PubMed  Google Scholar 

  27. R.S. Haber, A.K. Gupta, E. Epstein et al. Finasteride for androgenetic alopecia is not associated with sexual dysfunction: a survey-based, single-centre, controlled study. J. Eur. Acad. Dermatol. Venereol. 33, 1393–1397 (2019). https://doi.org/10.1111/jdv.15548

    Article  CAS  PubMed  Google Scholar 

  28. G.A. Zakhem, J.E. Goldberg, C.C. Motosko et al. Sexual dysfunction in men taking systemic dermatologic medication: a systematic review. J. Am. Acad. Dermatol. 81, 163–172 (2019). https://doi.org/10.1016/j.jaad.2019.03.043

    Article  PubMed  Google Scholar 

  29. R.C. Melcangi, V. Magnaghi, L. Martini, Steroid metabolism and effects in central and peripheral glial cells. J. Neurobiol. 40, 471–483 (1999)

    Article  CAS  Google Scholar 

  30. Y.S. Shin, K.K. Karna, B.R. Choi, J.K. Park, Finasteride and erectile dysfunction in patients with benign prostatic hyperplasia or male androgenetic alopecia. World J. Mens. Health 37, 157–165 (2019). https://doi.org/10.5534/wjmh.180029

    Article  PubMed  Google Scholar 

  31. E.R. Coskuner, B. Ozkan, M.G. Culha, Sexual problems of men with androgenic alopecia treated with 5-Alpha reductase inhibitors. Sex. Med. Rev. 7, 277–282 (2019). https://doi.org/10.1016/j.sxmr.2018.07.003

    Article  PubMed  Google Scholar 

  32. M.C. Uygur, A.I. Arik, U. Altug, D. Erol, Effects of the 5 alpha-reductase inhibitor finasteride on serum levels of gonadal, adrenal, and hypophyseal hormones and its clinical significance: a prospective clinical study. Steroids 63, 208–213 (1998). https://doi.org/10.1016/s0039-128x(98)00005-1

    Article  CAS  PubMed  Google Scholar 

  33. A. Hoque, S. Yao, C. Till et al. Effect of finasteride on serum androstenedione and risk of prostate cancer within the prostate cancer prevention trial: differential effect on high- and low-grade disease. Urology 85, 616–620 (2015). https://doi.org/10.1016/j.urology.2014.11.024

    Article  PubMed  PubMed Central  Google Scholar 

  34. B. Robaire, N.A. Henderson, Actions of 5α-reductase inhibitors on the epididymis. 250, 190–195 (2006). https://doi.org/10.1016/j.mce.2005.12.044

Download references

Funding

This work was supported by a grant from the Italian Ministry of Education and Research (MIUR-PRIN 2015XCR88M_006) and the University of Rome “Sapienza” Faculty of Medicine.

Author contributions

Conception and design of the work: F.P., F.L., D.P.; Carried out semen analysis: D.P; Hormonal analysis: A.F.R; Draughting the article: F.P., G.S; Final approval of the version to be published: F.L., D.P; Acquisition and analysis of data: M.P., T.C., F.C., F.P.; Patients recruitment: F.L., A.R.; Revising the paper critically: A.L. All authors read and approved the final paper.

Author information

Authors and Affiliations

  1. Laboratory of Seminology—Sperm Bank “Loredana Gandini”, Department of Experimental Medicine, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy

    Francesco Pallotti, Giulia Senofonte, Marianna Pelloni, Francesco Cargnelutti, Tania Carlini, Andrea Lenzi, Donatella Paoli & Francesco Lombardo

  2. Hormone Laboratory, Department of Experimental Medicine, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy

    Antonio F. Radicioni

  3. Division of Dermatology, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy

    Alfredo Rossi

Authors
  1. Francesco Pallotti
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Giulia Senofonte
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Marianna Pelloni
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Francesco Cargnelutti
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tania Carlini
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Antonio F. Radicioni
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Alfredo Rossi
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Andrea Lenzi
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Donatella Paoli
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Francesco Lombardo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Donatella Paoli.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

“All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards”.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Pallotti, F., Senofonte, G., Pelloni, M. et al. Androgenetic alopecia: effects of oral finasteride on hormone profile, reproduction and sexual function. Endocrine 68, 688–694 (2020). https://doi.org/10.1007/s12020-020-02219-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12020-020-02219-2

Keywords

Search

Navigation