Does stopping finasteride mean losing all progress? Here's what really happens

Finasteride is a prescription drug that slows hair loss by blocking DHT, the hormone that weakens susceptible follicles and thins hair. Users who have seen improvements often ask what happens if they stop taking it. This article summarises what the published studies and the community report.

What happens when you stop using finasteride?

The effect depends on continued use:

Finasteride works only while it is being taken. When it is stopped, DHT levels return to baseline and the protection against follicle miniaturisation ends.

You don't lose everything right away:

Hair does not fall out overnight. For the first few months after stopping, many people notice no drastic change. The manufacturer's label states that hair gained during treatment is generally lost within about 12 months of stopping, and community reports describe thinning returning over roughly 6 to 12 months.

Note: hair loss resumes after stopping finasteride Studies and the drug label describe finasteride as preventing further loss only while it is taken continuously. On discontinuation, scalp dihydrotestosterone (DHT) returns to its previous level and hair loss resumes, typically over 6 to 12 months, with hair progressively returning to its pre-treatment state.

Changes in neuroactive steroids after discontinuing finasteride:

Research has reported that, after stopping finasteride, some patients show altered levels of neuroactive steroids in both cerebrospinal fluid and plasma. Researchers have suggested these changes may relate to the persistent symptoms some men describe, known as post-finasteride syndrome (PFS). The study "Neuroactive steroid levels and psychiatric and andrological features in post-finasteride patients", published in The Journal of Steroid Biochemistry and Molecular Biology in 2017, examines this.

The authors suggest that altered neuroactive steroids could contribute to the neurological and psychological symptoms reported by some patients after stopping finasteride. This is a hypothesis under investigation, not an established mechanism.

Post-finasteride syndrome (PFS):

PFS describes sexual, neurological and psychological symptoms that persist after finasteride is stopped. Some men report reduced libido, erectile dysfunction and depressive symptoms, but the evidence on whether the drug causes lasting damage remains inconclusive and the condition has no agreed diagnostic definition. Researchers continue to call for larger studies to establish whether there is a causal relationship.

Semen quality after stopping finasteride

Finasteride has been associated with reduced sperm counts in some men. A 2013 study in Fertility and Sterility looked at men attending a male-infertility clinic who were taking finasteride, and reported that sperm concentration rose substantially after the drug was stopped. The authors described an average increase of roughly eleven-fold in that group. That group was men already being investigated for infertility, so the size of the change should not be read as what a typical user would see.

Persistent sexual dysfunction in some users:

Most sexual side effects associated with finasteride are reported to resolve after the drug is stopped, but some studies describe erectile dysfunction and reduced libido persisting beyond six months. A study published in The Journal of Sexual Medicine in 2011, "Persistent sexual side effects of finasteride for male pattern hair loss", interviewed men who had developed persistent sexual side effects in temporal association with the drug.

In that group, 94% reported low libido, 92% erectile dysfunction and 69% problems with orgasm, with a median symptom duration of at least 40 months and 20% reporting more than six years. These figures describe a self-selected group recruited from an online forum for men who already believed they had persistent side effects. They are not a rate for finasteride users in general, and the study was not designed to show that finasteride caused the symptoms. They do illustrate why the possibility should be discussed before starting or stopping treatment.

Community reviews on stopping finasteride

People who have taken finasteride describe varied experiences of stopping. One user reports regaining erections almost immediately after stopping, which suggests some sexual side effects can reverse quickly for some people. Others describe the opposite.

Another account describes hair receding noticeably after stopping both finasteride and minoxidil, and the distress this caused becoming severe enough to need medical care. This has fed a long-running community debate about whether stopping causes worse loss than would have happened anyway. Some users believe their hair ended up worse than before; others believe it simply returned to its untreated state. There is no published study settling this, and community accounts are individual experiences rather than evidence.

The topic also gets treated with humour. Satirical posts about hair vanishing the moment treatment stops reflect a frustration many users describe.

In summary, stopping finasteride involves some predictable changes and some uncertain ones. The studies and label agree that DHT returns to baseline and hair loss resumes over roughly 6 to 12 months, progressively returning to the pre-treatment state. Some people report regaining ground after restarting, but results vary between individuals.

If you are thinking about stopping, reducing or restarting finasteride, talk to the doctor or pharmacist who prescribed it first. They can advise on how to do it, what to expect, and what to do about any symptom that persists after you stop, including sexual or mood symptoms.

sources

Melcangi, R.C., Santi, D., Spezzano, R., Grimoldi, M., Tabacchi, T., Fusco, M.L., Diviccaro, S., Giatti, S., Carra, G., Caruso, D., Simoni, M. and Cavaliere, G. (2017). Neuroactive steroid levels and psychiatric and andrological features in post-finasteride patients. The Journal of Steroid Biochemistry and Molecular Biology, 171, 229-235. https://pubmed.ncbi.nlm.nih.gov/28408350/

Irwig, M.S. and Kolukula, S. (2011). Persistent sexual side effects of finasteride for male pattern hair loss. The Journal of Sexual Medicine, 8(6), 1747-1753. https://pubmed.ncbi.nlm.nih.gov/21418145/

Samplaski, M.K., Lo, K., Grober, E. and Jarvi, K. (2013). Finasteride use in the male infertility population: effects on semen and hormone parameters. Fertility and Sterility, 100(6), 1542-1546. https://pubmed.ncbi.nlm.nih.gov/24012200/