Impact of Hair Loss Treatments on Male Fertility and Semen Quality

Medication consultation

I want to treat my male pattern baldness, but my girlfriend and I also have plans for starting a family.
Therefore, I may avoid treatments that could affect fertility or lower androgen levels in the blood, while still needing to reduce the concentration of DHT (dihydrotestosterone) in the hair follicles.

1.
Will taking 5 mg of Finasteride daily affect semen quality? Are there systemic effects? Will it lower androgen levels in the blood? Will it affect the chances of conception? After conception, will Finasteride taken prior to conception have any effects on the fetus?
2.
Will taking 0.5 mg of Dutasteride daily affect semen quality? Are there systemic effects? Will it lower androgen levels in the blood? Will it affect the chances of conception? After conception, will Dutasteride taken prior to conception have any effects on the fetus?
3.
Will applying 200 mg of Azelaic Acid cream (containing 200 mg of Azelaic Acid per gram) to the scalp daily affect semen quality? Are there systemic effects? Will it lower androgen levels in the blood? Will it affect the chances of conception? After conception, will the use of Azelaic Acid cream prior to conception have any effects on the fetus?
Semen quality includes, but is not limited to, semen volume, sperm concentration, sperm morphology, and sperm motility.

Nìmíng, 40~49 year old female. Ask Date: 2023/04/27

Dr. Fu Shizhang reply Urology

There is no relevant research indicating that it affects semen quality or has an impact on the fetus; however, it may indeed affect hormone levels and erectile function.
Online consultations cannot replace an in-person evaluation and physical examination by a physician.
It is still recommended to seek medical attention at a healthcare facility when there are health concerns.

Reply Date: 2023/04/27

More Info

When considering treatment options for male pattern baldness (androgenetic alopecia), it's crucial to evaluate the potential impact on fertility and semen quality, especially if you have plans for starting a family. The three primary treatments you mentioned—Finasteride, Dutasteride, and topical Azelaic Acid—have different mechanisms of action and varying effects on hormonal levels and reproductive health.

1. Finasteride (5mg daily)
Impact on Semen Quality: Research indicates that Finasteride may have a minimal effect on semen quality. Some studies have shown a slight decrease in sperm count and motility in some men, but these changes are often not clinically significant and may not affect fertility.

Systemic Effects: Finasteride works by inhibiting the enzyme 5-alpha-reductase, which converts testosterone to dihydrotestosterone (DHT). This reduction in DHT can lead to hormonal changes, but the overall testosterone levels typically remain stable in most men.

Fertility and Conception: While there is no strong evidence suggesting that Finasteride significantly impacts fertility, it is advisable to consult with a healthcare provider if you are concerned. If you conceive while on Finasteride, there is no evidence to suggest that it would harm the fetus, but it is contraindicated for women who are pregnant or may become pregnant due to potential risks to male fetal development.

2. Dutasteride (0.5mg daily)
Impact on Semen Quality: Similar to Finasteride, Dutasteride may also affect semen quality, but the evidence is not conclusive. Some studies suggest a potential decrease in sperm parameters, but again, these changes are often reversible upon discontinuation of the drug.

Systemic Effects: Dutasteride is a more potent inhibitor of 5-alpha-reductase, affecting both type I and type II isoenzymes. This can lead to a more significant reduction in DHT levels compared to Finasteride, but testosterone levels generally remain unaffected.

Fertility and Conception: The same considerations apply as with Finasteride. There is no strong evidence indicating that Dutasteride adversely affects fertility. If you conceive while on the medication, there is no known risk to the fetus, but caution is advised for women who are pregnant.

3. Topical Azelaic Acid (200mg per gram)
Impact on Semen Quality: Topical treatments like Azelaic Acid are less likely to have systemic effects compared to oral medications. There is no evidence to suggest that topical Azelaic Acid affects semen quality or fertility.

Systemic Effects: Since Azelaic Acid is applied topically, it has minimal systemic absorption, which means it is unlikely to significantly alter hormone levels or affect fertility.

Fertility and Conception: Given its topical application and low systemic absorption, Azelaic Acid is considered safe for men planning to conceive. There is no evidence to suggest it would have any adverse effects on a developing fetus.

Conclusion
In summary, if you are concerned about the impact of hair loss treatments on fertility and semen quality, topical Azelaic Acid may be the safest option, as it is unlikely to affect systemic hormone levels or semen parameters. Finasteride and Dutasteride may have some effects on semen quality, but these are generally not significant enough to warrant concern for most men. However, individual responses can vary, and it is always best to consult with a healthcare provider to discuss your specific situation, especially when planning for a family. Regular monitoring and open communication with your partner about any concerns can help ensure a healthy approach to both hair loss treatment and family planning.

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