New 2026 Review Looks at Finasteride, Dutasteride and Male Fertility

If you’re a young man with hair loss, you might have asked yourself the question:

Could hair loss treatment affect my chances of having children one day?

It’s an important question.

Many of the men I meet in clinic are in their twenties and thirties. They may not be thinking about starting a family right now, but they hope to have children in the future.

A new review published in May 2026 looked at exactly this issue.

The paper examined the evidence surrounding two of the most commonly used medications for male pattern hair loss: finasteride and dutasteride.

First, a Quick Reminder

Finasteride and dutasteride are medicines used to treat androgenetic alopecia, also known as male pattern hair loss.

They work by lowering levels of a hormone called DHT (dihydrotestosterone).

DHT is one of the main reasons genetically susceptible hair follicles gradually become thinner and smaller over time.

For many men, these medications are effective at slowing hair loss and helping them keep more of their hair.

Why Did Researchers Look at Fertility?

Because these medications affect hormone pathways, researchers have long wondered whether they might also affect fertility and sexual function.

The authors of this new review gathered together studies looking at:

• Sperm count

• Sperm quality

• Hormone levels

• Sex drive

• Erectile function

• Long-term reproductive health

• 
  

Their aim was simple: to see what the evidence currently shows.

What Did They Find?

The review found that some studies reported changes in sperm quality in men taking finasteride or dutasteride.

These changes included:

• Lower sperm counts

• Lower sperm concentration

• Reduced sperm motility (how well sperm swim)

The review also found reports of sexual side effects in some men, including:

• Reduced sex drive

• Erectile dysfunction

• Changes in ejaculation

However, the findings were not the same in every study.

Some studies found significant effects.

Others found smaller effects.

And many men taking these medications reported no problems at all.

Does This Mean Finasteride Causes Infertility?

No.

This is probably the most important point in the entire paper.

The review does not conclude that finasteride causes infertility.

Many men take finasteride and go on to father children without difficulty.

What the authors are saying is that some studies have found changes in fertility-related measurements, and that these findings deserve further investigation.

In other words, there are still questions that science has not fully answered.

What About Long-Term Side Effects?

The review also discussed studies reporting sexual side effects that continued after treatment had been stopped.

This remains one of the most debated areas in hair loss medicine.

The authors highlight that some men have reported persistent symptoms, but they also acknowledge that more research is needed to understand exactly what is happening and how common it may be.

Why Does This Matter?

Imagine two men.

One is 55 years old and has completed his family.

The other is 25 years old, has a partner, and hopes to start a family as soon as possible.

They may look at the same treatment and view the potential risks very differently.

What Were the Limitations?

The authors are careful to point out that this review does not provide all the answers.

The studies included were different in size, design and quality.

Some relied on men reporting their own symptoms.

Some findings came from animal studies rather than human studies.

The review itself was a narrative review rather than a systematic review or meta-analysis.

The authors conclude that more long-term research is needed.

What Did the Authors Conclude?

The authors concluded that finasteride and dutasteride remain effective treatments for androgenetic alopecia.

However, they also concluded that these medications may affect reproductive parameters and sexual function in some individuals.

They suggest that men of reproductive age should be informed about these potential effects and that further research is needed to better understand the risks, particularly over the long term.

My Thoughts

I thought this paper was worth sharing because it looks at a topic that many young men with hair loss care about but may not always feel comfortable discussing.

Importantly, the authors do not suggest that finasteride or dutasteride should be avoided.

Nor do they suggest that every man taking these medications will experience side effects.

Instead, they highlight an area where important questions remain.

If you are considering these medications or already taking them, you deserve to be informed so you can make an informed choice for your own personal circumstances. I hope this blog - and the full research paper, go some way towards helping you with that.

Reference

Quintero T, Gratz B, Pepperney L, Rosenstadt J, Gallicano GI. Impact of 5-alpha reductase inhibitors on male reproductive health: A review of finasteride and dutasteride. Reproductive Toxicology. 2026.

If you’d like to read the full paper yourself, you can access it free of charge using the link provided by the publisher.

Update: New Study Presented in 2026

Shortly after this review was published, researchers presented additional data at the 2026 World Meeting on Sexual Medicine.

The study included 465 men, including 69 finasteride users and 396 controls. The average duration of finasteride treatment was just over six years.

The researchers reported that men taking finasteride had lower:

• Sperm concentration

• Total sperm count

• Total motile sperm count

• Sperm morphology

  
  

Interestingly, they found no significant differences in testosterone, free testosterone, follicle-stimulating hormone (FSH), luteinising hormone (LH), estradiol, sexual satisfaction, mood or psychological wellbeing.

The authors concluded that finasteride 1 mg daily reduced sperm production and morphology without significantly affecting hormonal balance, sexual function or psychological health.

Because these findings are currently available only as a conference abstract, the full peer-reviewed publication will be important to review once it becomes available.

Reference

Filho N, Afonso Teixeira T, Fraga LG, Torres Filho JS, Sanvido LV, Gismondi JP, Lozano AFQ, Hallak J. Finasteride 1 mg: Silent Impacts on Male Fertility Despite Preserved Hormonal Balance. Abstract qdag118.694. Presented at the 26th World Meeting on Sexual Medicine / Joint ISSM-ESSM Scientific Meeting, 2026.

Medical Disclaimer

This article is intended for educational purposes only and should not be taken as individual medical advice. If you are experiencing hair loss, speak to a suitably qualified healthcare professional.

Enjoyed This Article?

Stay up to date with the latest hair loss research, emerging treatments and practical advice from Dr Gwen Adey.

Get Free Hair Loss Research News