Ryan is a young 27-year-old lawyer from Nevada, USA, obsessed with baldness. Convinced that he was unattractive without hair and that he risked a sort of social isolation, he began the most popular therapy in America, finasteride, a drug that reduces the production of hormones. dihydrotestosterone (DHT), a hormone derived from testosterone. His hair grew back, though not to the extent of giving him the mane Ryan had dreamed of, but the brilliant young lawyer noticed other changes: his erection was no longer vigorous and his semen was watery. At that point, he went to the doctor, who prescribed him to immediately stop taking finasteride and prescribed a drug for erectile dysfunction, which returned his sex life to normal.
Finasteride, approved by the US Food and Drug Administration since 1997 For the treatment of male pattern baldness, it has become the most widely used treatment for hair loss among Americans, and is prescribed to millions of men in the United States each year. Its effectiveness is extremely high: approximately 80–90 percent of men achieve a halt or a marked slowing down of the progression of baldness; approximately 60–70 percent You may also notice some degree of regrowth or an increase in hair density.
In practical terms:
- Slow or stop the fall of hair in most men who take it.
- Promotes regrowth in a significant portion of patients, although the extent varies from person to person.
- It works best if started in the early or intermediate stages of hair loss, when the follicles are still viable.
Results can begin after 3-5 months of treatment, although in some cases you may have to wait up to 12 months before you see your first hair.
systematic review of 2024, which analyzed available clinical studies on the main treatments for androgenetic alopecia, including the title finasteride
“Management of androgenic alopecia: a systematic review of the literature” is published on
Journal of Cosmetic and Laser Therapy has shown that the benefits generally become evident after
6–12 months of continuous therapy and are maintained as long as the treatment is continued.
And here begin the contraindications and side effects of this “miraculous” anti-baldness therapy, as Ryan discovered with his personal experience.
First of all, finasteride cannot be stopped: if you stop treatment, DHT returns to previous levels and, within a few months, the hair preserved thanks to the treatment tends to be lost.
Then there are the side effects in the strict sense, starting from the most important ones:
- reduced libido;
- erection difficulties;
- decrease in ejaculate volume.
A Chinese study of March 2025, published in the magazine
Plos One analyzed large pharmacovigilance databases and confirmed that among the events reported as side effects of the use of finasteride against hair loss, there are:
- erectile dysfunction;
- reduced libido;
- depression;
- anxiety;
- suicidal ideation.
The impact of finasteride on sexual activity is linked to the drug 's effectiveness . Finasteride does not directly affect hair: it alters the metabolism of male sex hormones by reducing dihydrotestosterone (DHT), a hormone derived from testosterone through the enzyme 5α-reductase . Finasteride blocks this enzyme, decreasing DHT levels by approximately 60–70% in the blood and even more so in the scalp and prostate.
Since DHT also plays a role in male sexual function, it is plausible that in some people its reduction may affect: sexual desire (libido) ; erectile function ; ejaculate volume , because DHT contributes to the functioning of the prostate and seminal vesicles.
While it is understood that all specific assessments are the responsibility of the attending physician and the patient, we should always keep in mind that, in addition to medications, there are transplants and some natural remedies for baldness.
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