Analytical review of depression and suicidality from finasteride

What finasteride is and how it works

• Discussed as a very common drug for male pattern hair loss and enlarged prostate.
• Multiple comments correct the idea that it’s a “testosterone blocker”: it inhibits 5‑alpha reductase, reducing DHT while often slightly increasing serum testosterone and estrogen.
• Several note that DHT’s role in adult males outside hair/prostate is limited, but the endocrine system and receptor-level effects are complex and not fully understood.

Brain effects and proposed mechanisms

• The article’s main biological concern highlighted: finasteride crosses the blood–brain barrier and alters conversion of progesterone to allopregnanolone, a neurosteroid linked to mood; this gives a plausible pathway for depressive effects.
• Others argue the “masculinity/androgen” framing is oversimplified and that mechanisms in the brain may be distinct from peripheral hormone effects.

Evidence for depression/suicidality: quality and interpretation

• Some commenters see a clear logic: any drug that increases depression risk will, by extension, increase suicide risk.
• Others strongly question the article, noting it is a “narrative review,” not a proper meta‑analysis, and criticize its statistical reasoning and selective use of non‑randomized, database‑mining studies.
• FDA labeling is mentioned as including depression only as post‑marketing, self‑reported data; no established causal link to suicide yet.
• Concern raised that the review blurs correlation and causation.

Risk–benefit framing and ethics

• One extreme view calls for prosecuting executives/scientists; pushback argues this would chill drug development unless there is evidence of concealment or fraud.
• Multiple users emphasize that finasteride is widely used, generally well‑tolerated, and life‑changing for many who suffer severe distress from hair loss.
• Others counter that even a small rate of severe, possibly permanent adverse effects (e.g., “post‑finasteride syndrome”) is unacceptable for a largely cosmetic indication.

Anecdotal experiences: from life‑saving to life‑ruining

• Many report years of use (oral finasteride or dutasteride) with no noticeable side effects and major psychological benefit from preserved hair.
• Several describe clear negative experiences: new-onset depression, suicidal thoughts, vivid nightmares, sleep disturbance, sexual and “plumbing” issues, and lingering or permanent changes after cessation.
• There is disagreement whether persistent symptoms are likely: some argue no known mechanism once hormones normalize and suspect misattribution or trauma; others insist their damage is real and profound.

Confounders and selection effects

• Multiple commenters note that people distressed enough about hair loss to seek prescription treatment may already be at higher baseline risk of depression and suicidality.
• Analogies drawn to past debates over acne drug suicidality, where appearance-related distress was initially underappreciated as a confounder.
• One user cites data showing higher suicide attempts in alopecia areata, and others respond that this condition is different from common male pattern baldness but may still illustrate strong psychological impact of hair loss.

Hormones, trans data, and complexity

• Some bring in historical and trans HRT experiences to argue sex hormones clearly affect mood and suicidality.
• Others respond that extrapolating from trans hormone regimens to low-dose finasteride in cis men is inappropriate due to different drugs, doses, and contexts.
• Ongoing back-and-forth underscores that even if mood effects are real, predicting who will be affected and how remains unclear.

Formulations, combinations, and alternatives

• Question raised whether data differentiate oral vs topical finasteride; replies note the cited studies focus on oral use and that topical isn’t FDA‑approved, complicating research.
• Several note that finasteride is often combined with minoxidil; one suggests minoxidil-only as a safer alternative, others answer it doesn’t stop further loss.
• Some are baffled that anyone would take oral finasteride when topical exists; others implicitly accept systemic therapy as the current standard.

Meta: skepticism about online health advice

• A cautionary thread warns against treating HN comments as medical guidance, pointing out the mix of smart people and strong Dunning–Kruger effects.
• General agreement that more and better research is warranted, but that decisions ultimately involve personal risk tolerance, doctor consultation, and the trade-off between potential side effects and the psychological impact of baldness.