There has been a suggestion that sperm counts get depressed by finasteride. We know that this happens with dutasteride and this drug even produces azospermia (no sperm) with sterility in some men. The same may happen with finasteride, but the literature is not clear on it.  I have now seen many doctor refuse to write prescriptions for finasteride because of the medical-legal risks suggested by articles that discuss side effects that the doctor just doesn’t want to deal with. I continue to write these prescription but place these risks in a consent document that patients must sign.

https://www.fertstert.org/article/S0015-0282(13)02786-6/pdf

https://pubmed.ncbi.nlm.nih.gov/10495374/

https://pubmed.ncbi.nlm.nih.gov/26636418/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4969473/

All three of these research papers discuss the impact on scalp and systemic DHT.  Dutasteride reported a low incidence of sexual side effects 1.7% but although this number is thought to be low, if you subtract the placebo group from the sexual side effects group on finasteride it comes out about 2%.

This young man used just finasteride and microneedling for two months and got good results on his hair growth.