What does the FDA label say now?
The label tells two stories: what the trials found, and what has been reported since. In the controlled trials behind the Propecia label, sexual side effects were uncommon and mostly temporary.
| In the 1 mg trials | Finasteride | Placebo |
|---|---|---|
| Decreased libido | 1.8% | 1.3% |
| Erectile dysfunction | 1.3% | 0.7% |
| Ejaculation disorder | 1.2% | 0.7% |
| Any of these | 3.8% | 2.1% |
According to the label, these resolved in men who stopped because of them and in most who kept taking it, and each fell to 0.3% or less by the fifth year of treatment.
The postmarketing section is where persistence appears. It lists sexual dysfunction that continued after stopping treatment, including erectile dysfunction, libido, ejaculation and orgasm disorders, as well as depression and suicidal ideation and behavior. It also notes reports of male infertility or poor semen quality, which improved or normalized in some men after stopping. Because these reports are voluntary, the label says their frequency and cause cannot be reliably established.
The FDA returned to the topic in April 2025. Its alert on compounded topical finasteride described 32 adverse event reports from 2019 to 2024, including erectile dysfunction, anxiety, depression, brain fog and suicidal ideation, and said most reports stated the problems continued after the product was stopped.
How often do symptoms last after stopping?
Nobody knows the exact rate, but the estimates available so far are low. The most useful number comes from a 2017 study of Northwestern Medicine health records, which defined persistent erectile dysfunction as lasting at least 90 days after stopping and treated with ED medicine.
- Among 11,909 men exposed to finasteride or dutasteride for any reason, 1.4% developed persistent ED.
- Among 4,284 men aged 16 to 42 on hair-loss doses of finasteride, 0.8% did.
- In those younger men, longer use (more than about 205 days) raised the risk almost fivefold.
- Median persistence was roughly 3.7 to 4.2 years after stopping (1,348 and 1,534 days in the two groups).
Earlier evidence came from interviews. A 2011 study of 71 otherwise healthy men with symptoms lasting at least three months after stopping found most reported low libido and erectile dysfunction, with symptoms lasting a mean of 40 months by the time of interview. Because the men were recruited for having symptoms, it shows what persistent cases look like, not how common they are.
What do researchers think causes it?
The cause is not understood. A 2016 study at an academic center compared men with persistent symptoms with finasteride users who had none and with men who never took it. Testosterone, DHT and markers of androgen action were similar across all three groups, but the symptomatic men had higher depression scores and brain scan patterns consistent with those seen in depression.
On mood, a 2021 analysis of a global adverse event database found a signal for suicidality and psychological side effects in men under 45 using finasteride for hair loss, but not in older men using it for an enlarged prostate. The authors noted the signal may partly reflect increased reporting after 2012, and that younger men may be more vulnerable.
What should you do if side effects start?
Tell the clinician managing your finasteride early, rather than waiting to see if things settle. The two of you can decide whether to stop and whether other causes, such as stress, relationship changes or low testosterone, deserve a look.
If you have thoughts of harming yourself, call or text 988 to reach the Suicide and Crisis Lifeline, or call 911. That comes before any appointment.
Related question: why do some men choose PRP instead?
Because it does not act on hormones. PRP uses your own platelets, and its side effects are mostly local soreness or swelling for a day or two. The trade-off is weaker evidence and the need for maintenance, since PRP does not block DHT. Our comparison of PRP versus finasteride lays out that trade, and using PRP and finasteride together covers the middle path.
How Ultimate Male handles finasteride questions
At our San Gabriel and Downey clinics, hair restoration with PRP is the core service, and finasteride comes up in most hair consultations. The provider talks through the label data above without overstating or downplaying it, along with the PSA effect covered in PSA on finasteride.
If you are already on finasteride and have symptoms, you can expect a careful history and, where it helps, labs to check for other explanations. Our finasteride for hair loss page has more on how the medicine works and is monitored.
