Is it safe to have children on finasteride?

sup Chums how y'all living hope everything is Nova and you're all having apreme week so one of the most common questions I get about theaster is whether or not it is safe to take it if you're trying to have a baby with your partner well first of all the good news is that because you have hair you'll actually have a partner who will want to breed with you to begin with so that's another reason to be thankful for finasteride of course when you are passing on your jeans to Future Generations you don't want there to be any complications and have your baby grow up to be Jason Blaha so hair loss witchers they need assurance that their predy will be safe while they fight the slap head curse so the first question that is often asked is whether finasterid affects male fertility I already did a video on that which I'll link below so that's not going to be the main focus of this video but I will Briefly summarize the data on fertility here so there was a double blind randomized controlled study on the effect of finid on sperm function back in 1999 the results of this study were reassuring because there was no effect from finasteride that was found on sperm production or on sperm function in some of the subjects there was a small decrease in ejaculate volume and prostate volume that was reversible upon stopping the drug the decrease in ejaculate volume was only an 11% decrease but in the placebo group The ejaculate also decreased by 8% so the absolute difference in ejaculate volume was only 3% however the total number of sperm per each ejaculate did not decrease so you can't consider this to be some form of birth control so sometimes you will hear people complain about how finastra gives them A reduced ejaculatory volume but it doesn't really matter because finasterid will not stop your partner from conceiving because even if the semen volume is lower the sperm count is still about the same since that study though there have been a number of case reports like this one here which I actually covered in my last video in the article a couple was being evaluated for infertility and miscarriages and the 37-year-old male spouse who was on finasterid at 1 milligram daily was found found to have normal semen volume normal sperm concentration and normal sperm motility meaning normal sperm movement the doctors did find increased sperm DNA fragmentation which improved upon stopping finasteride however there had been no measurement of the sperm DNA fragmentation before starting finasteride so the case report doesn't show that finasteride was the cause of the problem also despite stopping finasteride the couple remained infertile so whether the DNA fragmentation was the cause of the fertility problem is anyone guess it's also possible the woman was the one who was infertile the authors of the study did recommend that a trial of stopping finasterid would perhaps be useful in infertile men but that would only be something to be considered in a man who has fertility issues to begin with so besides case reports like that one there is a database study published in 2013 that looked at finasteride use in men presenting to a fertility clinic in this study of 4,400 infertile men only 27 which is just 0 0 6% were on finasteride these men were advised to stop finasteride and after being off of finasteride for an average of 6 months they had some improvement in their sperm counts and their sperm motility however to put this data into perspective we are only talking about data on 14 men and we don't know if there were other treatments going on in these men who after all were being seen in a fertility clinic for the treatment of low sperm counts also there is a statistical phenomenon called regression towards the mean what that means is that if you have an extreme low measurement like in these men then the next measurement is likely to be closer to the average value which will be higher what this means is that someone with a low sperm count one day is likely to have a higher sperm count on another day just by chance alone so that can give a false impression of a treatment effect even when there really isn't a treatment effect at all so the authors of this study also conclude that an infertile or subfertile men on finasteride it would be worth giving it a trial of temporary discontinuation the study doesn't tell us anything about the incidence of fertility problems with finasteride and it doesn't imply that men with normal fertility are likely to lose their fertility as a consequence of taking finasteride fortunately there is one more important study this time another randomized controlled study specifically this one here in the study 99 men were randomized to receive either dutasteride at 0. 5 milligram per day finasteride at 5 milligram per day or a placebo blood and semen samples were collected at Baseline and after 6 and 12 months of treatment as well as 6 months after treatment was stopped as you would expect serum DHT levels dropped with the 5 AR blockers and serum testosterone levels went up looking at Sean there were mild decreases in sperm counts semen volume sperm concentrations and sperm motility with the five air blockers compared to Placebo there was no change in sperm morphology though the authors considered much of these changes relatively minor probably without much impact on fertility they State quote the impact of these compounds on fertility is unclear especially because average sperm concentration ations decreased only slightly remaining above 20 million per milliliter in all but two subjects one on dutasteride and one on Placebo a recent studies suggested that sperm concentrations greater than 12 million per milliliter are adequate for normal fertility unquote the authors concluded that there were mild decreases in semen parameters that were reversible with discontinuing the drug however the changes were not large enough to actually affect fertility in the vast majority of cases they did recommend that men with low sperm counts to begin with who are taking 5 a blockers that it is worth stopping the drugs to temporarily improve fertility if they desire to be fertile so why did this randomized trial show somewhat different results than the other one well one possibility is that the study used 5 milligrams of finasteride a day versus the other study that used just 1 milligram per day so it's not clear that the results apply to the hair loss population that uses just 1 milligram per day which in the previous study had no effect whatsoever on sperm counts or sperm function now we know that 5 milligrams per day is is not Superior to 1 milligram per day when it comes to hair loss and we also know that 5 milligrams per day doesn't suppress more DHT than 1 milligram per day and I talk about that in my optimal dose of finasteride video link below nevertheless we are talking about five times the standard dose of finasteride that is used for the treatment of hair loss so it is at least theoretically possible that there is some yet to be found mechanistic explanation for the difference in effects on sperm parameters on 5 migr per day versus 1 milligram per day it is important to remember though that these effects on fertility are all very slight even on 5 Mig of faster per day it is still very very minor the only time that fertility would be affected would be if there were already a pre-existing fertility problem to begin with so for the vast majority of men fertility issues while in for nide is of no concern whatsoever so let's switch from questions about fertility to questions about risk of the fetus is a man who uses finasteride at any risk of endangering his unborn child let's go ahead and find out first of all the package AG insert for finasteride says that women should not use finasteride and that women shouldn't handle crushed or broken finasteride tablets when pregnant or potentially pregnant due to the risk to a male fetus it's worth mentioning that some women do use finasterid for hair loss and that finasterid is an effective treatment for women who have androgenic alopecia which like in men is the most common cause of hair loss finasteride is safe for women just so long as they are taking the precautions against pregnancy or if they can't get pregnant to begin with I talk about this more in my video on the treatment of hair loss women which I'll link below but the notion that women should never take finasteride is completely absurd because it is assuming that women don't know how to control their own fertility which is Insel black pill rhetoric [ __ ] but to be perfectly clear women who are pregnant or who are trying to get pregnant cannot use finasteride the reason the tablets are coded is to prevent finasterid from being absorbed through the skin if women touch the tablets so woman handling that just the tablet is probably okay to do so just so long as it isn't broken so if you're like me and like a quarter 5 milligram finasteride tablets then just make sure your partner doesn't touch them this is the only reason why the tablets are Co at all it's not to enhance stomach absorption or cause a slow release of the drug or anything like that that's a pretty common misconception there's no reduction in the efficacy of finasteride if you cut the pills and I have a video about that which I'll link below anyways the reason finasteride is bad for male fetuses is because in the uterus at least DHT is not a trash hormone it is actually responsible for the development of the male genitalia in the womb in the landmark 1974 study on men in the Dominican Republic born with low DHT levels as a result of a 5r enzyme deficiency it was found that the affected male babies were often mistakenly raised as girls fortunately for them when puberty hit they had normal genital development showing that in puberty genital development depends on testosterone levels and not DHT however in the uterus DHT is an essential hormone for male genital development so clearly women taking finasteride during pregnancy would be at risk to have male babies with abnormalities of their genitalia and this has been shown in animal research too for example this rat study from way back in 1990 was done before even finasterid was approved by the FDA at the time it was still undergoing trials and was known by the code name of mk96 the study found that a dose of 0. 1 millgram per kilogram per day of finasteride given to female pregnant rats cause genital abnormalities in some of the baby male rats at the extremely high dose of one 100 Mig per kilogram per day 100% of the babies had birth defects the researchers concluded quote the risk assessment based on the induction of hypospadius indicates that the exposure of women of childbearing potential to even relatively low levels of MK 096 should be avoided unquote just to explain this better hypospadia is an abnormality of the male genitals it was because of this very research that the warning for women of childbearing age was to avoid finasteride and that was added to the package insert so even though it is clear that women can't take finasteride while pregnant the big question is can women have sex with men who are taking finasteride is there enough finasteride in the semen to cause birth defects well this question actually has been well researched because we have this study from 1997 done on Reese's monkeys this is a better study than the rat study because monkeys are more closely related to humans than Rats on The evolutionary tree as a control group the pregnant female monkeys were given oral finasteride at a dose of 2 Mig per kilogram per day this would be the equivalent for an average human of about 100 to 200 Mig per day as expected this dose did cause genital abnormalities in the baby male monkeys they gave the other group of monkeys intravenous doses of finasteride at doses of 8 80 or 800 nanog per day these doses were more comparable to the amount of finasteride that was found to be present in human seen in men taking finasteride in fact the 800 nanogram dose per day was 60 times the semen levels of finasterid in men on five Mig daily and it was 750 times the semen levels of finasteride in men on 1 milligram of finasteride per day the levels of finasteride in human seen ranges from less than 0.

1 to 10. 54 nanog per milliliter of seen and Men chronically on 5 milligrams daily of finasteride and from less than 0. 1 to 1.

52 nanog per Miller of seamen and Men on 1 millgram of finast per day so the researchers determined that assuming an average ejaculate volume of 5 milliliters and assuming 100% absorption through the vagina the highest exposure to finasteride would be less than 100 nanog per day and this is only if you make the very generous Assumption of sexual intercourse twice per day however intravenous doses of up to 800 nags a day in these pregnant monkeys produce no birth effects at all and like I said these doses were up to 750 times higher than the seamen finasterid levels that were seen in men taking 1 milligram of finasteride daily so clearly here even if your partner is a big bigger nyphomaniac than Megan Fox and you shoot loads bigger than Peter North you're still not going to be putting your unborn son at any risk of birth effects and the researchers agree with me here though they stated their conclusions in a slightly more gential fashion they concluded that the exposure of pregnant women through the seen of men taking finasteride was not a risk at all for the human fetus well the data is reassuring for monkeys but what about human fetuses are there any reports of birth effects in human babies that are related to finasterid well not surprisingly it is difficult to find any case reports of birth effects that actually are related to finasterid so here is one that probably isn't worth mentioning but I'll go over it anyways just to provide an example so this case report it is from 2009 but it is actually a report of a 41-year-old woman taking finasterid for alipa who inadvertently took it during pregnancy she was on 1 milligram per day she delivered a baby girl with some hand in figer abnormalities the authors felt that this was the first case report of any birth effects in humans related to Finas they say quote to our knowledge this is the first case report of finasterid used during pregnancy in a human it is not clear if these deformities are related to finasteride use in pregnancy but it is worthwhile to document a possible Association and focus attention on the possibility of limb deformities in such cases unquote actually I doubt this case had anything to do with finasteride at all development of the hand and fingers has nothing to do with DHT and hand and figer abnormalities are common birth effects to begin with also this woman was 41 which is pretty old to be having kids we know that the incidence of birth effects increases with age so is possible this birth effect was related to her relatively Advanced age for being the mother of a newborn also this was a baby girl and we wouldn't expect finasteride to affect female fetuses who have a low level of DHT compared to male fetuses so this is a valuable study but I still wanted to bring it up just to show how limited and rare the research on finasteride and birth effects are to begin with so the next study is a little more relevant it is from 20 2015 and comes from you guessed it good Korea the patients in the study came from a woman's clinic in good Korea there were 19 cases of pregnant women where the father had been taking finasteride when the women got pregnant so of these 19 women 13 women gave birth to normal full-term babies there were three intentional abortions and three miscarriages you could see all the details in this table here so there were no birth effects in the baby's born at full term clearly the three medical abortions had nothing to do with finasteride among the the three miscarriages though one woman was taking the drug diazapam which is rated a Class D drug for pregnancy meaning there is evidence of human fetal risk when pregnant women take the drug so there were no genital abnormalities or other birth effects in the babies whether the spontaneous abortions had anything to do with finasteride is not clear which the authors admit they say quote the rate of abortion in our data doesn't necessarily mean that finasteride is a definite cause of early pregnancy loss unquote well there's one other reassuring case report here this this case is from 2018 and it actually describes a 39-year-old woman who was taking 2.