TLDR Finasteride's sexual side effects not caused by androgen deficiency or SRD5A inhibition.
This document is a response to a letter regarding a study on men who reported persistent sexual symptoms after using finasteride for hair loss. The authors of the study defend their conclusion that the symptoms are unlikely to be due to androgen deficiency or persistent inhibition of SRD5A activity. They also discuss the findings of a functional magnetic resonance imaging (fMRI) study on the neurobiology underlying sexual function and dysfunction, which revealed commonalities in the regions identified in different studies. The authors agree that a possible causal relationship will likely only be demonstrated in a well-designed large prospective observational study.
Cited in this study
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50 citations
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September 2016 in “The Journal of Clinical Endocrinology and Metabolism” Finasteride for hair loss may cause persistent sexual symptoms, depression, anxiety, and lower quality of life.
December 2021 in “Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature” 3 citations
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May 2020 in “Journal of The Korean Medical Association”
November 2014 in “PharmaTutor” Finasteride may help postmenopausal women with hair loss but is not effective for all and should be used cautiously in premenopausal women.
August 2014 in “Journal of drug discovery and therapeutics”
January 2013 in “e-Jurnal Medika Udayana” 
10 citations
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June 2001 in “PubMed” Finasteride is effective in growing hair and stopping hair loss in men with mild to moderate alopecia.
June 2001 in “International Journal of Cosmetic Surgery and Aesthetic Dermatology” Finasteride improves hair growth in men with androgenetic alopecia.
65 citations
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October 1999 in “Journal of The American Academy of Dermatology” Finasteride effectively reduces hair loss by decreasing androgen levels.
30 citations
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August 1992 in “The Journal of Clinical Endocrinology and Metabolism” Finasteride doesn't affect hormone levels in normal men.
