Sexual Dysfunction in Those with Androgenetic Alopecia on Dutasteride Versus Finasteride

Among males with androgenetic alopecia using dutasteride and those using finasteride, new findings suggest that both treatments have similar risks for sexual dysfunction.1

These findings on dutasteride and finasteride, both classified as 5-alpha-reductase inhibitors (5ARIs), are the results of an analysis of the 2 treatments’ impacts on those with androgenetic alopecia related to sexual health and related adverse events (AEs). The 2 treatments are commonly prescribed for treating androgenetic alopecia and benign prostatic hyperplasia.

The study was authored by such investigators as Zachary Neubauer, a dermatology research fellow at Thomas Jefferson University. Neubauer and colleagues noted that potential for sexual dysfunction related to 5ARI utilization in androgenetic alopecia remains debated, with patient perceptions appearing to play a notable role.2

“To help dermatologists counsel patients with [androgenetic alopecia] on 5ARI-related [sexual dysfunction] risk, we used a large database to compare [sexual dysfunction] risk between dutasteride and finasteride in patients with [androgenetic alopecia],” Neubauer et al wrote.1

The TriNetX Research Network was implemented by the investigative team in their search, with the team’s research being conducted in June 2024. The investigators looked at male patients with an androgenetic alopecia diagnosis or with non-scarring hair loss from 2004 - 2024 who had no previous sexual dysfunction diagnosis.

Each participant was assigned to be in either the dutasteride or finasteride cohorts, with no overlap ensured by Neubauer and coauthors. The Kaplan–Meier survival analysis and Cox proportional hazards modeling was used to assess sexual dysfunction, with the investigators adjusting for age, nicotine dependence, race/ethnicity, hypertension, diabetes, overweight/obesity, and previous mood disorders. The data were expressed as hazard ratios (HR) with 95% confidence intervals (CI).

There were 411 men in total who had been treated with dutasteride and 27,131 who had been treated with finasteride. On average, the investigative team highlighted the slightly older age of dutasteride users compared to finasteride users (36.3 versus 34.7 years; P = .0054). The team also noted a lack of significant difference in the racial and ethnic compositions of the 2 cohorts (P > .05). Mean follow-up durations had been 670 days for those on dutasteride and 1,192 days for those on finasteride.

There was no statistically significant difference observed by Neubauer et al between the 2 arms of the study in the participants’ risk of sexual dysfunction. Specifically, the investigators noted that their Kaplan–Meier analysis yielded an HR of 1.36 (95% CI: 0.89–2.09), and their Cox model returned an HR of 1.37 (95% CI: 0.90–2.08).

Despite such conclusions, they did note certain factors as significantly associated witb increased risk, including Hispanic/Latino ethnicity (HR = 1.47; 95% CI: 1.21–1.77), older age (HR = 1.02; 95% CI: 1.02–1.02), history of hypertension (HR = 1.47; 95% CI: 1.28–1.69), and the presence of prior mood disorders (HR = 1.47; 95% CI: 1.29–1.68). Overall, however, the data support the previously established conclusion that dutasteride and finasteride maintain comparable risk profiles in men living with androgenetic alopecia.

Neubauer and coauthors acknowledged their study’s limitations, highlighting the reliance on accuracy in coding, the study’s retrospective design, and the lack of information confirming adherence to the patients’ medication. They also commented that sexual dysfunction reports may be impacted by the expectations of participants, potentially leading to overreporting, or social desirability, potentially resulting in underreporting.

A direct assessment of the ‘nocebo effect’ was not possible here, but the investigative team highlighted that this is unlikely to have differentially affected the 2 cohorts. They reason that both medications are usually accompanied by similar counseling about the possible side effects of use.

“This information can guide treatment decisions without increasing patient anxiety about potential AEs, thereby minimizing the impact of the nocebo effect,” the investigators concluded.1 “Taken together with previous literature, our study emphasizes that there is likely no difference in [sexual dysfunction] risk between 5ARIs.”

References

1. Neubauer Z., Ong M.M. and Lipner S.R. (2025), Similar Risk of Sexual Dysfunction in Androgenetic Alopecia Patients Treated With Dutasteride vs. Finasteride: A Retrospective Cohort Database Study. Int J Dermatol. https://doi.org/10.1111/ijd.17887.

2. K. C. Lauck, A. Limmer, P. Harris, and D. Kivelevitch, “Sexual Dysfunction With 5-Alpha-Reductase Inhibitor Therapy for Androgenetic Alopecia: A Global Propensity Score Matched Retrospective Cohort Study,” Journal of the American Academy of Dermatology 91, no. 1 (2024): 163–166, https://doi.org/10.1016/j.jaad.2024.03.019.