The NHS wrote:  This US study looked at a medical records database to see how common erectile dysfunction (impotence) was among men prescribed two drugs, dutasteride and finasteride, both used to treat non-cancerous prostate enlargement. The drugs work by blocking the male hormone testosterone. A low dose of finasteride is also used to treat male pattern baldness.

Overall they found that around 1 in 17 of all men prescribed either drug for prostate enlargement had erectile dysfunction. This figure fell to 1 in 31 of those prescribed finasteride for baldness. Using the drug for longer was generally linked with a higher risk. However, in 99% of men, stopping the drugs solved the problem so it wasn’t as catastrophic as the media implies.

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.

This patient had a hairline lowering procedure. The scar is a complication of this type of surgery, especially when the wound is placed under tension.  To avoid this, a low tension closure is critical but this often limits how much the hairline can be lowered. A hair transplant lowering surgeon, of course, does not have this problem.  To correct this, a hair transplant should be done in front of the hairline to bury the scar so it can’t be seen. There seems to be enough room for hair grafts to make such a surgery successful. IF the scar still shows after the hair transplant, Scalp Micopigmentation will work well to camouflage it.

I’m open to new ideas:  https://interestingengineering.com/reversing-baldness-with-an-electric-hat

Remarkable results from finasteride in just 4.5 months. This young man must have been very sensitive to finasteride