Finasteride use in the male infertility population effects on semen and hormone parameters

Capsule:
Finasteride may cause reduced sperm counts in some men, but sperm counts improve dramatically for most after discontinuation. Finasteride should be used with caution in men who desire fertility.

Authors:
Mary K. Samplaski, M.D., Kirk Lo, M.D., Ethan Grober, M.D., Keith Jarvi, M.D.

Volume 100, Issue 6, Pages 1542-1546, December 2013

Abstract:

Objective:
To determine the degree of improvement in semen parameters after finasteride discontinuation.

Design:
A prospective database of men presenting for a fertility evaluation was analyzed for semen and hormone parameters before and after discontinuation of finasteride.

Setting:
A male infertility specialty clinic.

Patient(s):
Men presenting for fertility evaluation from 2008–2012 on finasteride.

Intervention(s):
None.

Main Outcome Measure(s):
Semen and hormone parameters before and after discontinuation of finasteride.

Result(s):
At presentation, 27 (0.6%) of 4,400 men on finasteride. The mean duration of treatment with finasteride was 57.4 months, and mean dose was 1.04 mg/day. There was an average 11.6-fold increase in sperm counts after finasteride discontinuation. Of the men with severe oligospermia (15 M/mL after finasteride cessation. No man had a decrease in sperm count. There was no change in hormone parameters, sperm motility, or sperm morphology.

Conclusion(s):
Finasteride, even at low doses, may cause reduced sperm counts in some men. In this population, counts improved dramatically for the majority of men after finasteride discontinuation. The hormone parameters, sperm motility, and sperm morphology were unchanged after cessation. Finasteride should be discontinued in subfertile men with oligospermia, and used with caution in men who desire fertility.

  • José Martínez-Jabaloyas

    Congratulations to the authors for this excellent article. It is difficult in the clinic to
    establish a relationship between male infertility and finasteride treatment. In
    my experience I think that, in some patients, finasteride treatment can affect
    to semen parameters, but this is difficult to demonstrate. The manuscript of
    Samplaski et al shed light on this question and it allows establish, whit the
    adequate precautions according the limitations of the study, that low doses of
    finasteride can affect to semen parameters in some patients. So, I think that
    it is necessary to counsel to patients that are taking finasteride and that
    have fertility problems to stop temporarily the treatment. In the other hand, I
    think that is more probable that the mechanism for finasteride-induced
    infertility is the alteration of spermatogenesis instead of epididymal
    dysfunction because the first parameter affected is sperm counts and not sperm
    motility or morphology. Finally, according the data reported in the article of
    Samplaski et al, we can say that, in the same way that finasteride can affect
    to sexual function in some patients, it is possible that it can affect to
    fertility in predisposing males.

  • I applaud Samplaski and colleagues for providing this retrospective study from their institution. They provide important data on the effects of low dose finasteride (1mg) on sperm counts. We have long known the effects of full dose finasteride (5mg) on fertility but the effects of 1 mg on fertility have been mixed at best due to limited studies and patient populations.

    Important take home points:
    1. Finasteride at even 1 mg can depress sperm counts
    2. Cessation of medication can result in a 11.6 fold improvement in sperm counts
    3. Time frame of improvement after cessation is undetermined
    4. It is important to counsel men seeking fertility to stop or avoid finasteride even at low doses altogether.

Translate »