A new report on the mental health side effects of finasteride, a drug commonly prescribed to treat male pattern baldness, is raising alarms among healthcare experts and the public alike. The commentary, published in The Journal of Clinical Psychiatry, highlights the growing body of evidence suggesting that finasteride may increase the risk of depression and suicide in men. This finding has reignited concerns about the long-term safety of the drug and the need for more thorough research into its potential mental health effects.
What is Finasteride?
Finasteride is a medication used to treat two primary conditions: benign prostatic hyperplasia (BPH) in men with enlarged prostates, and androgenetic alopecia, commonly known as male pattern baldness. The drug works by inhibiting the enzyme 5-alpha reductase, which converts testosterone into dihydrotestosterone (DHT), a hormone that plays a significant role in hair loss. For its use in treating BPH, a higher dose of 5 mg is typically prescribed, while for hair loss, the standard dose is 1 mg.
Approved by the FDA in 1992 under the brand name Proscar for BPH, and in 1997 under the brand name Propecia for hair loss, finasteride has been on the market for decades. The drug has helped millions of men combat hair thinning and other related conditions, but recent reports are causing some to question the safety of its use, particularly for cosmetic purposes.
The New Report: A Warning About Mental Health Side Effects
The recent commentary authored by Dr. Mayer Brezis, a professor of medicine at Hebrew University in Jerusalem, examines the growing body of research that links finasteride to increased risks of depression, anxiety, and suicidal thoughts. The article criticizes the drug’s manufacturer, Merck, as well as federal regulators like the FDA, for not doing enough to address these serious mental health side effects.
According to Brezis, the risks associated with finasteride have been underestimated or downplayed for years. He claims that hundreds of thousands of men may have suffered from depression as a result of taking the drug, with some tragically losing their lives to suicide. Brezis argues that the failure to conduct more thorough studies on the mental health risks of finasteride has allowed these dangers to go largely unrecognized until now.
Over the past two decades, he says, the delayed recognition of these risks has allowed widespread harm to occur among men who took the medication primarily for cosmetic reasons. According to Brezis, the lack of warning from both Merck and the FDA has been particularly troubling, as the drug’s side effects have been known since the early 2000s.
A Call for More Research
Brezis’ commentary, while alarming, is not calling for an immediate halt to the use of finasteride. Instead, it stresses the importance of conducting more rigorous research to better understand the full extent of its mental health implications. Healthcare experts interviewed by Healthline agreed that the findings provide valuable insights, but noted that further studies are needed before making sweeping changes to the drug’s usage recommendations.
Dr. Ramkishen Narayanan, an urologist and director of the Center for Urologic Health at Providence Saint Joseph Medical Center, acknowledged that the report raises important points for consideration. However, he stressed that there is not yet enough conclusive evidence to completely alter the way finasteride is prescribed. He emphasized that the benefits of the drug—particularly in treating hair loss and BPH—continue to outweigh the risks for many men.
Dr. Anthony Oro, a professor of dermatology at Stanford University, was similarly cautious. He pointed out that the commentary is based on existing studies that link finasteride to mental health issues, but it does not represent definitive research. Oro emphasized that the drug’s potential side effects, while concerning, need to be studied further before any drastic conclusions can be drawn.
Finasteride and Suicide Risk
The commentary highlights several studies published between 2017 and 2023, which found a significant increase in the risk of depression, anxiety, and suicidal behavior among men taking finasteride for hair loss. These studies were based on data mining from healthcare records and adverse event reporting systems, and they suggest that the mental health risks associated with finasteride are not only immediate but can persist even after discontinuing the drug.
The FDA first acknowledged the mental health risks of finasteride in 2011, when it added depression to the drug’s label as a possible side effect. In 2022, the agency went a step further and included suicidality as a potential risk. Since then, more than 700 cases of suicidal thoughts or suicide attempts have been reported to the FDA, involving individuals who had taken finasteride.
Dr. Brezis’ report also notes that the majority of the studies examining finasteride’s mental health risks have focused on individuals taking the 1 mg dose for hair loss. Notably, there appears to be no similar increase in depression or suicide risk in patients taking the higher 5 mg dose for BPH. This discrepancy suggests that the risks might be more pronounced in men using finasteride for cosmetic reasons, particularly those who may already be dealing with low self-esteem or body image issues due to hair loss.
Why the Link Between Finasteride and Mental Health Matters
Hair loss can have a profound psychological impact on men, particularly younger men who may struggle with their self-esteem or body image as a result. According to Dr. Ken Williams, a surgeon specializing in hair restoration, many men who seek treatment for hair loss already experience psychological distress, such as depression or anxiety, related to their appearance. Therefore, introducing a medication like finasteride, which has been linked to mental health issues, may exacerbate underlying conditions.
The link between finasteride and mental health concerns underscores the importance of addressing psychological well-being alongside physical health when prescribing medications. Experts argue that a holistic approach should be taken when considering treatments for hair loss, and that mental health screenings may be necessary before prescribing the drug.
What’s Next for Finasteride?
Despite the concerns raised by the new report, many experts believe that finasteride can still play a valuable role in treating hair loss and BPH. However, the growing body of evidence pointing to potential mental health risks suggests that further research is needed to better understand the long-term effects of the drug.
In his commentary, Dr. Brezis calls for immediate changes in how finasteride and similar drugs are approved, monitored, and prescribed. He recommends suspending the marketing of finasteride for cosmetic purposes until its safety can be thoroughly established. He also advocates for more rigorous studies, including systematic recording of drug histories in suicide investigations, to better understand the risks associated with the drug.
Conclusion
While the risks associated with finasteride cannot be ignored, the drug’s benefits for many men still outweigh the potential downsides, particularly when it comes to treating BPH. However, the recent report serves as a stark reminder that more research is needed to fully understand the mental health side effects of finasteride, especially for those taking the drug for cosmetic reasons. Until more conclusive evidence is available, medical professionals are urged to take a careful, individualized approach when prescribing finasteride, considering both the potential benefits and risks, as well as the patient’s mental health history.
