Australian retrospective data has suggested that lowering the dose of finasteride can improve things downstairs while also maintaining hair growth up top.
Patients experiencing sexual side effects while taking finasteride may get the best of both worlds by reducing their dose instead of stopping cold turkey.
New Australian research, published in the Journal of the American Academy of Dermatology, has suggested that dose reduction may be a viable option for male pattern hair loss patients taking finasteride who experience sexual side effects.
A retrospective review of patient records identified 100 men treated with oral finasteride who went on to develop sexual side effects (average age 35.5 years). Most men were taking 1mg (43%) or 0.5mg (34%) of finasteride, while a smaller proportion of participants were taking 1.25mg (9%), 0.75mg (1%), and 0.25mg (13%). Sexual side effect symptoms first appeared an average of 42.0 weeks after initiating treatment, with 83% of patients reporting reduced libido, 35% reporting erectile dysfunction, and 6% ejaculatory dysfunction.
Patients were grouped based on the course of action following sexual side effect onset: discontinuing treatment (24%), tapering treatment (48%), and continuing treatment at their current dose (28%). The patients who did not change their dose had a longer period between treatment onset and the development of sexual side effects (average of 57.9 weeks) compared to men who tapered (38.4 weeks) or discontinued (30.9 weeks) their treatment.
Across the entire cohort, 73% of patients reported a resolution of the sexual side effects after an average of 26.7 weeks. Unsurprisingly, a greater proportion of men who stopped taking finasteride saw a reversal of the sexual side effects (95.8%, after an average 20.2 weeks) than men who tapered (75.0%, 31.6 weeks) or maintained (50.0%, 26.1 weeks) their dose.
“Among tapered patients, side effects persisted after the first dose reduction in 16 of 48 patients,” the researchers wrote. “Of these, four achieved resolution with a second taper, while 12 ultimately discontinued treatment.”
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The researchers noted that finasteride showed similar effectiveness (with respect to restoring hair counts) at doses ranging from 0.2mg to 1mg, stating that “this pharmacodynamic plateau likely explains why modest dose reductions improve tolerability without substantially compromising efficacy”.
They also suggested topical finasteride could be used in patients who cannot tolerate lower oral doses, citing that none of the five patients who made the switch to topical formulations in the current study reported sexual side effects.
Differences in androgen receptor sensitivity, 5α-reductase expression, and psychological factors were put forward as potential explanations as to why sexual side effect symptoms.
“Our findings suggest patient experiencing sexual side effects with oral finasteride, especially those taking 1mg, may benefit from tapering to 0.5mg daily, which resolved side effects in 75% of cases and enabled treatment continuation,” the researchers concluded.
Journal of the American Academy of Dermatology, 1 October 2026
