How do you counsel male patients with Androgenetic Alopecia who are trying to conceive about using dutasteride or finasteride?

I advise against dutasteride for those trying to conceive or who might have unprotected intercourse with pregnant women since dutasteride is in the semen. For 5 alpha-reductase inhibitors in general, the effects on sperm count and sperm motility are very well characterized. There is a reduction in sperm count and sperm motility, but on their own, the reduction is typically not enough to cause infertility. However, in conjunction with another factor for infertility, it can be a problem.

My counseling, therefore, is that if they are having difficulty conceiving, then it is reasonable to stop their 5 alpha-reductase inhibitor. Dutasteride has a longer half-life and may take 6 months to clear whereas finasteride should take no more than one mo...