Finasteride-associated male infertility

Abstract

Finasteride is a potent and specific inhibitor of the 5α-reductase enzyme in men. Clinical studies have shown that finasteride 1mg/day is effective for promoting hair growth in men with male pattern hair loss. However, there is a concern about the use of finasteride, especially in young fertile patients, because of its action on testosterone metabolism. This paper describes 3 cases of young patients who had very poor seminal quality during finasteride treatment (1 mg/day), and their seminal quality greatly improved after cessation of finasteride treatment. Two of them presented with a left varicocele and the other was obese. We hypothesize that finasteride may not dramatically change the spermatogenesis process in healthy men, but in patients with conditions related to infertility, an amplification of the negative influence of finasteride could occur. Future studies should be done to clarify the extent of the effect of finasteride in patients fertility problems. Finasteride is a potent and specific inhibitor of the 5α-reductase enzyme. 1 It inhibits the conversion of testosterone to dihydrotestosterone (DHT). 2 Dihydrotestosterone is the most potent androgen, and its level directly affects prostate development.It is known that the use of 5α-reductase enzyme inhibitors like finasteride, when administered at 5 mg/ day, reduce the prostatic size around 20% to 30%. 3 Finasteride has been used for the treatment of benign prostate hyperplasia. Clinical studies have shown that finasteride 1 mg/day is also effective in promoting hair growth in men with male pattern hair loss. 4 There has been a concern regarding the use of finasteride, especially in young patients, because of its action on testosterone metabolism. Overstreet et al. (1999) demonstrated in a prospective clinical trial that treatment with finasteride 1 mg/day does not affect spermatogenesis or the spermatozoa production in young healthy men. 1 However, Kinniburg et al. (2001) showed that the use of finasteride promotes a significant reduction of the serum level of DHT, decrease of the plasma seminal volume, and the suppression of gonadotropin secretion, resulting in impairment of spermatogenesis. 2 O'Donnel et al. (1999) showed in an animal model that the use of finasteride promoted partial inhibition of spermatogenesis. 2 A Medline review searching with the key words finasteride and fertility produced 3 papers related to the positive influence of finasteride on the fertility, but none of them were performed with humans. Cukierski et al. (1991) and Wise et al. (1991) showed that in rats the administration of 80 mg/kg/day of finasteride decreased fertility. 5,6 According to Iguer-Ouada et al. (1997), finasteride (1 mg/kg) promoted an increase in sperm concentration and decrease in volume of prostatic secretion in male beagle dogs. 7 The effects on the fertility of a long period of finasteride treatment are not completely defined.The aim of this study was describe 3 cases of young male patients who consulted for infertility and showed severe decrease of spe...

Dermatological medication effects on male fertility

“…In contrast, a report of two infertile males with severe oligospermia or azoospermia demonstrated that 6 months after finasteride was discontinued, sperm concentration significantly improved . Another report of three cases demonstrated abnormal sperm motility and concentration while taking finasteride 1 mg/day, reversed or improved after 3–4 months . One case report showed that after 3 months of discontinuing finasteride, sperm DNA fragmentation index significantly reduced, indicating an association between the use of finasteride and sperm DNA damage .…”

Topical application of Polygonum multiflorum extract induces hair growth of resting hair follicles through upregulating Shh and β-catenin expression in C57BL/6 mice

“…Minoxidil is a popular hair growth promoting drug, but it is reported that it can cause adverse dermatological effects such as pruritis, dryness, scaling, local irritation, dermatitis (DeVillez, 1990). Finasteride is also a widely used hair growth promoting drug for androgenic alopecia patients, which is not recommended for female patients (Glina et al, 2004;Kaufman et al, 1998). It is reported that minoxidil is efficacious in promoting hair growth in patients with androgenic alopecia by inducing hair follicles to undergo transition from the early to late anagen phase (Gregoriou et al, 2010;Tsuboi et al, 2009).…”

Finasteride-associated male infertility

“…In this study, the investigators concluded that spermatogenesis was not adversely affected by the drug; however, they targeted only ''fertile'' male patients, excluding patients with, for example, abnormal screening semen analysis, history of infertility, cryptorchidism, and varicocele. To date, two case reports have suggested that 1 mg finasteride is associated with male infertility (7,8). Glina et al reported three cases of young patients who had very poor seminal quality during 1-mg finasteride treatment.…”

“…Only one study has reported the effect of 1 mg finasteride. This double-blind, placebo-controlled multicenter study included only healthy men with normal spermatogenesis and did not show any effect on semen parameters (6); however, two case reports have described patients with impaired spermatogenesis that was reversed after the cessation of 1 mg finasteride (7,8). In this case report, we describe a male patient who consulted our clinic for infertility and showed almost total azoospermia during treatment with 1 mg finasteride.…”