Hair loss is a common issue among men, with androgenetic alopecia (male-pattern baldness) affecting nearly half of all men by age 50. Androgenetic alopecia is a genetically determined condition which can start any time after puberty and as early as 20 years of age. While this condition is not physically harmful, it often has a profound impact on self-esteem and well-being, especially for young men, leading many to seek treatment.
With many men taking a greater interest in their looks, hair loss treatments are never too far away and can easily be found on the internet with little advice or screening. Concerns have been raised about potential side effects, particularly regarding male fertility.
In this article we explore the effects of various hair loss treatments on male fertility, focusing on the scientific findings, hormonal mechanisms involved, and considerations for men who may be planning a family.
Finasteride and Dutasteride
Finasteride and Dutasteride are oral medications that reduce the conversion of testosterone into dihydrotestosterone (DHT), a hormone closely linked to hair loss. By lowering DHT levels, these drugs slow hair loss and may even promote regrowth.
Hormonal background on DHT
Dihydrotestosterone (DHT) is a potent androgen derived from testosterone. DHT plays an essential role in developing male characteristics, such as body hair, a deeper voice, and genital maturation during puberty. In adults, it influences prostate health, sexual health, and the growth of body hair. Unfortunately, DHT also contributes to hair loss by shrinking hair follicles in those genetically predisposed to androgenetic alopecia.
How Finasteride and Dutasteride affect hormones
Both, Finasteride and Dutasteride block the enzyme 5-alpha-reductase, responsible for converting testosterone into DHT. By inhibiting this enzyme, these medications lower DHT levels without directly affecting testosterone levels.
- Finasteride inhibits type II 5-alpha-reductase, which primarily targets DHT production in the scalp and prostate, reducing DHT levels by about 60-70%.
- Dutasteride, on the other hand, inhibits both type I and Type II 5-alpha-reductase, making it more potent and reducing DHT levels by over 90%.
Fertility impact
Lowering DHT with these medications can affect sperm parameters. Studies have shown that Finasteride can reduce sperm count, motility, and semen volume in some men, although this effect is usually reversible after stopping the drug.
By blocking DHT, these medications can alter the delicate hormonal feedback system essential for sperm production. Some men experience an increase in testosterone levels, but others may experience side effects such as reduced libido or erectile dysfunction, likely due to the hormonal imbalance caused by low DHT.
Most of the fertility-related side effects are reversible within three months after discontinuation of Finasteride or Dutasteride, but individual recovery times vary, and many men may be completely unaware of how the medication is impacting their fertility.
While Finasteride and Dutasteride are effective for hair loss, men concerned with fertility should be aware of the risks. Men planning to conceive may consider pausing these medications temporarily under medical guidance to minimise potential reproductive side effects.
Minoxidil
Minoxidil is a topical treatment that promotes hair growth by increasing blood flow to hair follicles. Unlike Finasteride and Dutasteride, Minoxidil does not alter hormone levels; it primarily acts at the site of application.
Fertility impact
Minoxidil’s absorption into the bloodstream is minimal, making it unlikely to affect sperm production, quality, or hormone levels. Since it does not interact with testosterone or DHT, Minoxidil has no known hormonal effects on fertility.
Minoxidil appears to have minimal to no impact on male fertility, making it a safer choice for men who are concerned about reproductive health.
Dosage and duration of use
Higher doses and long-term use of medications like Finasteride and Dutasteride are more likely to impact sperm quality and hormone levels. This is especially relevant for men taking higher doses of Finasteride (e.g., 5 mg) for conditions like benign prostatic hyperplasia (BPH), which can have a greater impact on DHT levels.
Individual sensitivity
Men vary in their hormonal sensitivity; while some may experience noticeable fertility impacts from DHT-lowering medications, others may not. Genetic factors and pre-existing health conditions can also affect how these treatments influence an individual’s hormonal balance and fertility.
Concurrent health conditions
Underlying health conditions, such as hormonal imbalances or urological disorders, can amplify the effects of hair loss medications on fertility. Men with existing fertility concerns may benefit from consulting a reproductive specialist before starting DHT-lowering treatments.
Alternatives and mitigating risks
For men concerned about fertility, there are alternative strategies to manage hair loss:
- Topical Treatments: Minoxidil and other natural treatments, such as caffeine-based shampoos or certain plant oils (e.g., pumpkin seed oil), may help manage hair loss without impacting fertility.
- Low-level laser therapy (LLLT): Laser caps and combs stimulate blood flow to hair follicles and promote hair growth without hormonal effects, making them a safe alternative.
- Consultation with healthcare providers: A doctor can help monitor potential fertility effects when using hair loss treatments, particularly if a patient is taking Finasteride or Dutasteride.
Conclusion
Hair loss treatments, particularly DHT-lowering medications like Finasteride and Dutasteride, can have varying effects on male fertility. While many men use these treatments without experiencing significant reproductive issues, those planning a family should weigh up the benefits and potential risks carefully.
For men concerned about the effects on sperm quality and overall fertility, alternatives such as Minoxidil, hair transplants, or low-level laser therapy offer hair loss solutions with minimal or no reproductive side effects.
However, with so many products on the market it’s imperative that men properly research their treatment options and understand the fertility risks involved.
For men who are already using hair loss treatments and trying to conceive it is strongly recommended that they consult with a male fertility specialist to understand all the options available to them.
Research
Overstreet JW et al. (2003). Finasteride, a type 2 5α-reductase inhibitor, does not affect spermatogenesis in healthy men. Journal of Urology, 169(4), 1455-1458.
Amory JK et al. (2007). The effect of 5α-reductase inhibition with dutasteride and finasteride on spermatogenesis and semen parameters. Journal of Clinical Endocrinology & Metabolism, 92(5), 1659-1665.
Makridakis N & Reichardt JK (2016). Molecular mechanisms of androgenetic alopecia. Journal of Investigative Dermatology Symposium Proceedings, 12(1), 3-5.
Shapiro J & Kaufman KD (2003). Use of finasteride in the treatment of men with androgenetic alopecia (male pattern hair loss). Journal of Investigative Dermatology, 121(5), 32-40.
Gupta AK & Charrette A (2015). Topical minoxidil: Systematic review and meta-analysis of its efficacy in androgenetic alopecia. Skin Therapy Letter, 20(6), 6-10.
Avila CR et al. (2018). Efficacy and safety of low-level laser therapy for androgenetic alopecia: A review of the literature. Lasers in Medical Science, 33(2), 421-430.
Irwig MS (2012). Persistent sexual side effects of finasteride for male pattern hair loss: Could they be permanent? Journal of Sexual Medicine, 9(11), 2927-2932.
Habib FK et al. (1994). Comparison of the inhibition of type 1 and type 2 5α-reductase isoenzymes by finasteride and dutasteride in hyperplastic human prostate. European Urology, 26(1), 12-16.