Which Hair Loss Pills Have Been Linked to Erectile Dysfunction?
Not every hair loss pill is linked to ED — and much of the research is still evolving. It’s important to speak to your doctor about what types of hair loss pills may be best for you based on your health history, existing conditions, and concerns.
“As with any long-term therapy, shared decision-making and regular monitoring ensure patients maintain both confidence and safety throughout treatment,” says Dr. Houman.
Finasteride and Erectile Dysfunction
Finasteride (brand names Propecia and Proscar) is an oral prescription medication used to treat hair loss in men.
Finasteride may lead to erectile dysfunction through its impact on male sex hormones. It blocks the 5α-reductase enzyme (a protein that speeds up chemical reactions in the body) that converts testosterone into dihydrotestosterone (DHT).
By lowering DHT levels, finasteride may reduce hormone activity in the prostate, penis, and nervous system. “The reduction of these hormone levels can interfere with the body’s ability to make nitric oxide which is important for libido, mood, and erections, explains Houman. “The result can be diminished sexual desire, weaker erections, or delayed orgasm in some men,” he adds.
The connection between hair loss pills and ED was discovered in research, including a 2018 meta-analysis that found men taking finasteride had a higher risk of sexual side effects compared with a placebo.
Other Hair Loss Drugs That Have Not Been Linked to Erectile Dysfunction
For men concerned about sexual side effects, there are other hair loss treatments that may carry lower risk.
Topical Finasteride Finasteride is also available in a topical spray, though no topical finasteride product has been approved by the U.S. Food and Drug Administration (FDA) for treating hair loss.
Topical finasteride significantly improves hair count compared to a placebo — similar to oral finasteride — but with less impact on DHT levels. In one randomized controlled trial, topical finasteride lowered DHT levels by nearly 35 percent, whereas oral finasteride lowered them by more than 50 percent.
“Topical finasteride seems to have less sexual side effects than oral finasteride, however patients can still develop sexual side effects from the topical form,” says Aron Nusbaum, MD, a board-certified dermatologist and hair loss specialist with the Miami Hair Institute in Florida, and hair loss specialist with the American Hair Loss Association. Topical finasteride still enters your bloodstream, but at more than 100 times lower levels than oral finasteride — meaning it’s less likely to cause whole-body side effects, including sexual side effects related to lowered DHT.
Minoxidil Minoxidil (Rogaine) is a topical over-the-counter treatment commonly used to stimulate hair growth. There is also an oral form of minoxidil, but it doesn’t have FDA approval for treating hair loss like the topical form. The oral form is used to treat high blood pressure, though some providers do prescribe it for hair loss with few reported side effects.
Research on minoxidil has largely focused on fertility rather than erectile dysfunction. Currently, there is no scientific consensus that it adversely affects male fertility, with research either mixed or inconclusive.
“For men concerned about sexual health, alternatives like minoxidil may offer a better risk-benefit profile,” says Houman. “It is generally well tolerated, though it carries cardiovascular rather than sexual risks.” It’s particularly important to speak to your doctor about the risks and benefits of minoxidil if you have heart disease, since it can cause fluid buildup or make problems resulting from heart attack or stroke worse.
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