Finasteride Sexual Side Effects and Post-Finasteride Syndrome: What the Trials, the Label and the Reviews Say
In trials, sexual side effects on finasteride were uncommon and mostly resolved. The label also lists cases that continued after stopping. What is known, what is not, and when to stop and call.
By Kymata Health Editorial Published Last checked
This guide
Finasteride- Question
- How common are finasteride's sexual side effects, and is post-finasteride syndrome real?
- Sources
- 4 cited
- Quick answers
- 2 questions
- Clinician review
- None; sources cited inline
Key takeaways
5 points- In 1-year trials, 3.8% of men on finasteride reported decreased libido, erectile dysfunction or an ejaculation disorder, vs 2.1% on placebo1.
- These resolved in men who stopped and in most who continued, and fell to 0.3% or less by year 51.
- A meta-analysis of 15 randomized trials found a 1.66-fold risk of sexual dysfunction with finasteride 1 mg2.
- The label lists sexual dysfunction that continued after stopping, depression and suicidal ideation among post-marketing reports, which cannot show how often they occur1.
- A 2020 review found post-finasteride syndrome can be neither confirmed nor ruled out as a distinct condition3.
What the trials found
In the label's 1-year trials (945 men on finasteride, 934 on placebo), decreased libido affected 1.8% vs 1.3%, erectile dysfunction 1.3% vs 0.7% and ejaculation disorder 1.2% vs 0.7%, and 1.2% vs 0.9% stopped because of sexual side effects1. Overall, 3.8% vs 2.1% reported one or more1.
A 2019 meta-analysis of 15 double-blind, placebo-controlled trials (4,495 men) found a 1.57-fold risk of sexual dysfunction with 5-alpha-reductase inhibitors overall and 1.66-fold with finasteride 1 mg2.
Symptoms that continue after stopping
The label's post-marketing section lists sexual dysfunction that continued after stopping (erectile, libido, ejaculation and orgasm disorders), male infertility or poor semen quality, testicular pain, depression, and suicidal ideation and behavior1. Post-marketing reports come from a population of unknown size, so they cannot give a rate or prove cause1.
Persistent sexual, mental and physical symptoms after stopping are sometimes called post-finasteride syndrome. A 2020 review concluded that studies so far can neither confirm nor rule it out as a distinct condition, and that if it exists it seems to affect susceptible people3. The FDA's 2025 alert on compounded topical finasteride described reports in which most problems persisted after stopping4.
What to do
Men with a history of depression, sexual dysfunction or infertility should weigh finasteride carefully with the prescriber3. Tell your prescriber promptly about mood changes or sexual side effects, and get help right away for thoughts of self-harm (in the US, call or text 988).
For results, pregnancy rules and topical options, see the finasteride hub.
Quick answers
Questions
2 answersDo finasteride's sexual side effects go away?
In the trials they resolved in men who stopped and in most who continued1; the label also lists post-marketing reports of dysfunction that continued after stopping1.
Is topical finasteride free of sexual side effects?
No topical finasteride is FDA-approved, and the FDA's alert described reports including erectile dysfunction after compounded topical use4.
More in Finasteride
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- Previous in this topicFinasteride and Minoxidil Together: What Combination Trials Show for Men's Hair LossThe two drugs work in different ways, and trials that paired them found more men with marked improvement than either alone, with similar side effects.
- Next in this topicTopical vs Oral Finasteride: What the Spray Trial Shows and Why US Topicals Are CompoundedA finasteride spray beat placebo in a 24-week European trial and looked similar to tablets.
- Dutasteride vs Finasteride for Men's Hair Loss: What the Head-to-Head Trials Show, and the Safety Trade-OffsIn 24-week head-to-head trials, dutasteride 0.5 mg grew more hair than finasteride 1 mg.
- Minoxidil: Topical vs Oral, for Men and Women, by the Trials and the LabelsMinoxidil foam and solution are sold over the counter to regrow scalp hair in men and women.
- Men's Hair Loss: Finasteride, Minoxidil and Laser Caps, by the EvidenceFinasteride and minoxidil are the two FDA-approved drugs for male pattern hair loss, with the largest and longest trials.
References
Every study and document cited in this guide, numbered as in the text.
Sources
4 sources- 1PROPECIA (finasteride) tablets, film coated: prescribing information. DailyMed, U.S. National Library of Medicine, 2024.
- 2Adverse Sexual Effects of Treatment with Finasteride or Dutasteride for Male Androgenetic Alopecia: A Systematic Review and Meta-analysis. Acta Derm Venereol, 2019. PMID 30206635
- 3Post-finasteride syndrome. An Bras Dermatol, 2020. PMID 32317131
- 4FDA alerts health care providers, compounders and consumers of potential risks associated with compounded topical finasteride products. U.S. Food and Drug Administration, 2025.
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