Is it safe for a man taking finasteride (for benign prostatic hyperplasia or androgenetic alopecia) to conceive, or should it be stopped before attempting pregnancy?

Finasteride and Male Fertility During Conception Attempts

Men taking finasteride for benign prostatic hyperplasia or androgenetic alopecia do not need to discontinue the medication when attempting to conceive, as current evidence shows no clinically significant impact on offspring outcomes or birth defects.

Key Evidence from FDA Labeling and Guidelines

The FDA label for finasteride explicitly addresses male exposure and conception safety 1:

• Semen exposure to partners is negligible: Finasteride concentrations in semen range from undetectable to 10.54 ng/mL in men taking 5 mg daily, which represents 50-to-100-fold less than the dose that has no effect on circulating DHT levels 1
• No developmental abnormalities in offspring: Animal studies showed no abnormalities in offspring of untreated females mated with finasteride-treated male rats receiving approximately 61 times the maximum recommended human dose 1
• Reversible effects on semen parameters: Treatment for 24 weeks showed no clinically meaningful effects on sperm concentration, mobility, morphology, or pH, with only a 0.6 mL median decrease in ejaculate volume that was reversible upon discontinuation 1

Guideline Consensus on Male Medication Use

The most recent 2025 EULAR guidelines on antirheumatic drugs in reproduction provide the strongest framework for understanding male medication safety during conception 2:

• Drugs safe for male conception: Multiple medications that would be discontinued in women before pregnancy (including methotrexate, leflunomide, and mycophenolate) showed no evidence of increased risk for birth defects when used by male partners 2
• High disease activity impairs fertility more than medications: Controlling underlying conditions with compatible drugs is the best strategy, as untreated disease itself may impair male fertility 2

Clinical Evidence from Real-World Use

Research evidence supports the safety profile:

• No documented adverse pregnancy outcomes: Despite millions of men taking finasteride, there are no reports of adverse pregnancy outcomes among partners of men using the medication 3
• Successful conception after long-term use: A case report documented successful full-term pregnancy and healthy live birth after the male partner used finasteride for approximately 10 years, with conception occurring shortly after discontinuation 4
• Maternal exposure through semen is safe: A case where both partners were taking finasteride resulted in a healthy male infant with no dysmorphic features or genital abnormalities 5

Practical Management Approach

For men currently taking finasteride who wish to conceive:

• Continue finasteride without interruption, as there is no evidence of harm to offspring 1, 3
• Reassure partners that semen exposure poses no risk to pregnancy or fetal development 1, 3
• If subfertility is present, consider temporary discontinuation for 3-4 months to assess whether finasteride is contributing, though this is rarely necessary 4

Important caveats:

• Female partners should never handle crushed or broken finasteride tablets due to potential direct fetal exposure if pregnant 1
• Intact, coated tablets are safe to handle during normal use 1
• The primary concern with finasteride is direct maternal exposure during pregnancy, not paternal use during conception 1

Contrast with Female Exposure Guidelines

This recommendation differs markedly from guidance for female medication use. For comparison, statins must be discontinued 1-2 months before conception in women 2, and multiple other medications require discontinuation periods of 2-6 months 6, 7. However, these restrictions apply only to female patients, not male partners attempting conception.