Finasteride and Male Fertility

Finasteride is a drug used to treat benign prostatic hyperplasia and male pattern baldness. It inhibits the conversion of testosterone to dihydrotestosterone (DHT). There are reports of fertility issues in men taking the drug. Studies have shown that finasteride can decrease semen parameters, but spermatogenesis is not adversely affected. In some cases, discontinuing the drug can improve semen parameters. Finasteride does not have negative effects on erectile function. However, caution is warranted for its administration, especially in infertile men. Hyperprolactinemia is a common cause of infertility in males and females. It inhibits the pulsatile secretion of the gonadotrophin-releasing hormone, which causes decreased pulsatile release of follicle-stimulating hormone, luteinizing hormone, and testosterone, which in turn causes spermatogenic arrest, impaired sperm motility, and altered sperm quality. It later produces secondary hypogonadism and infertility. Hyperprolactinemia also directly influences spermatogenesis and steroidogenesis by acting on prolactin receptors present in Sertoli cells and Leydig cells in testes, and produces primary hypogonadism and infertility. It can be managed medically with simple medication, such as bromocriptine and cabergoline, which normalizes serum prolactin levels, restoration of gonadal function, reversing infertility caused by hyperprolactinemia and induces reduction in the prolactinoma size in the majority of patients.