Sexual Dysfunction Associated With 5α-Reductase Inhibitors in the Treatment of Androgenetic Alopecia: A Systematic Review

June 2026 in “ Frontiers in Medicine ”

Aleksandra Złotowska, Beata Jastrząb-Miśkiewicz, Piotr K. Krajewski

5α-reductase inhibitors androgenetic alopecia finasteride dutasteride sexual dysfunction decreased libido erectile dysfunction topical finasteride 5-ARIs AGA Propecia Avodart

This systematic review examines the sexual dysfunction associated with 5α-reductase inhibitors (5-ARIs) used for treating androgenetic alopecia (AGA). Analyzing 41 studies, it finds that sexual adverse events, such as decreased libido and erectile dysfunction, occur in 1.9–6.7% of men taking oral finasteride and 4.1–12.0% for dutasteride, with lower rates for topical finasteride. These effects are generally mild, reversible, and not consistently reported in women. Clinicians should inform patients about these potential side effects, emphasizing their infrequency and reversibility, while advocating for shared decision-making and further research to better understand individual susceptibility and long-term risks.

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