Should I stop taking finasteride before trying to conceive and if so, how long before?

Should You Stop Finasteride Before Trying to Conceive?

Yes, you should stop finasteride at least 3 months before attempting to conceive, as evidence suggests it may impair sperm DNA integrity and potentially affect fertility, though the risk to a developing fetus from paternal use is extremely low.

Recommended Timeline for Discontinuation

• Stop finasteride 3 months before attempting conception 1, 2
• This 3-month window allows for one complete cycle of spermatogenesis (approximately 74 days) plus additional time for sperm maturation 2
• Sperm DNA fragmentation index (DFI) has been shown to improve significantly within 3 months of finasteride cessation, with continued improvement at 6 months 2

Why Discontinuation is Recommended

Effects on Male Fertility

• Sperm DNA damage: Finasteride has been associated with elevated sperm DNA fragmentation, which can increase pregnancy loss risk even when standard semen parameters appear normal 2
• Oligospermia: One case report documented severe oligospermia 3 months after stopping finasteride following 10 years of use, though sperm concentration improved over subsequent months and spontaneous conception occurred 1
• The effects on sperm parameters may be amplified in subfertile patients 1

Recovery Pattern After Stopping

• Sperm concentration and DNA integrity begin improving within 1-3 months of discontinuation 1, 2
• In the documented case of long-term finasteride use, conception occurred approximately 5 months after cessation 1
• Sexual adverse effects (decreased libido, erectile dysfunction) typically resolve upon discontinuation 3

Risk to the Baby if You Continue Taking Finasteride

Paternal Exposure (Your Concern)

• The risk to the fetus from paternal finasteride use is extremely low 4
• Finasteride at 1 mg daily does not have clinically significant effects on semen parameters in most men 4
• There are no documented reports of adverse pregnancy outcomes from paternal finasteride exposure through semen 4, 5
• The amount of finasteride transferred through semen is negligible and unlikely to cause fetal harm 4

Maternal Exposure (For Context)

• Finasteride is absolutely contraindicated in pregnant women due to risk of hypospadias (genital abnormalities) in male fetuses 5, 3
• However, this applies to maternal ingestion, not paternal use 4
• One case report of maternal finasteride use during early pregnancy resulted in a healthy male infant with no genital abnormalities, though this single case does not establish safety 5

Clinical Reasoning

While the theoretical risk to a fetus from paternal finasteride use is minimal, the primary concern is your fertility potential 1, 2. The evidence suggests finasteride may:

• Impair sperm DNA integrity, potentially increasing miscarriage risk 2
• Cause temporary oligospermia in some men 1
• Require several months for full recovery of optimal sperm quality 1, 2

Important Caveats

• If you have known subfertility issues, the effects of finasteride may be more pronounced 1
• Consider sperm DNA fragmentation testing if you've been on finasteride long-term and are planning conception, as standard semen analysis may appear normal despite DNA damage 2
• The single documented case of successful pregnancy after long-term finasteride use took approximately 5 months post-discontinuation 1
• Early studies suggested minimal effects on semen, but more recent observations indicate potential problems, particularly in subfertile men 1

Practical Recommendation

Stop finasteride 3 months before actively trying to conceive to allow for optimal sperm quality recovery 1, 2. While continuing finasteride poses minimal direct risk to a developing fetus through semen exposure 4, it may reduce your chances of achieving pregnancy and potentially increase early pregnancy loss risk through sperm DNA damage 2.