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

ObjectiveTo determine the degree of improvement in semen parameters after finasteride discontinuation.DesignA prospective database of men presenting for a fertility evaluation was analyzed for semen and hormone parameters before and after discontinuation of finasteride.SettingA 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 (<5 M/mL), 57% had counts increase to >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.