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Analytical review of depression and suicidality from finasteride
- agnishom 1y agoCan someone give us more context? Why is Finasteride of particular interest?
- whatwhaaaaat 1y agoHair loss drug. Commonly prescribed.
- LoganDark 1y agoI assume it's a drug to treat hair loss, not a drug to cause hair loss?
- nemomarx 1y agoYeah - it's a selective testosterone blocker, kind of, and tries to target the part that causes male pattern baldness without lowering overall T Levels. I assume it still blocks enough hormones to cause mood shifts or other effects?
- chimeracoder 1y ago> Yeah - it's a selective testosterone blocker, kind of, and tries to target the part that causes male pattern baldness without lowering overall T Levels. > I assume it still blocks enough hormones to cause mood shifts or other effects? Endocrinology is a lot more complicated than you're giving it credit for. DHT blockers don't necessarily lower testosterone levels; they can actually increase it (although even then, the mechanism isn't as direct as you might think). It's neither established nor a given that any side effects of finasteride have anything to do with effects on testosterone or hormone levels at all. A lot of people make that assumption, and there's reason to suspect there's truth to that hypothesis, but it's completely possible it's an unknown side effect of the drug, and there hasn't been enough study into the mechanism to understand it (in part because the side effects are relatively rare and weakly established).
- wizzwizz4 1y agoBlocking the conversion of testosterone to DHT (the effect of this medication) causes an indirect and minor increase in both testosterone and œstrogen levels, although DHT is more potent than testosterone for the receptors in many tissues.
- anon373839 1y agoIt’s not a testosterone blocker at all. It blocks 5-alpha reductase, an enzyme that converts testosterone to DHT. It can actually increase serum testosterone by more than 10%. As for DHT, that hormone doesn’t appear to have much significance for adult males. It’s critically important in puberty, though!
- deleted 1y ago[deleted]
- michael_michael 1y agoA.k.a. Propecia.
- koolba 1y agoI think it’s also for treating enlarged prostates.
- _--__--__ 1y agoIt's one of the most commonly used DTC prescription drugs and is used for a purely cosmetic purpose, so debates about it are common online and full of low-quality motivated reasoning.
- anonymousiam 1y agoFinasteride is also used (in higher dosage) to reduce the size of the prostate gland.
- timr 1y ago> ...is used for a purely cosmetic purpose I know you probably didn't mean it this way, but Finasteride started as a treatment for prostate enlargement, and is still used for that.
- tehnub 1y agoSelf-perception can have a profound effect on one's physical and mental wellbeing, so even drugs which are for cosmetic purposes can be important for health.
- lithocarpus 1y agoTrue, and, I'd posit that there are often better and safer alternatives that would be similarly or more beneficial with less potential for harmful side effects. I have several anecdotes from my own life. When I was ~18 the doctor proposed to give me jaw surgery to fix my overbite by extending my lower jaw. I asked him what the reasons for this were and he said it was mainly cosmetic. I thought this was not a good enough reason for surgery - which while often safe does also often have harmful side effects - I now know way too many people who had surgery complications that often took a long time for them to become aware of. I think I feel better about myself now for having made that choice than I imagine I would if I had a better jaw line. It's true that some people are going to have a story where they see the cosmetic medical intervention as having been beneficial for their mental wellbeing. I'd still suggest that in many such cases there might have been other ways to get a better outcome. It's for each of us to decide. Still, burden of proof of the safety of a drug should be on the company profiting from it.
- nick__m 1y agoIt decreases dihydroxytestosterone to treat hair loss.
- viking123 1y agoThis is the hormone that makes you bald (if you got bad cards in the genetic lottery) and also makes your prostate the size of an apple. Also causes acne as a bonus, again a bit dependent on genetics. Amazing.
- m0llusk 1y agoExactly what finasteride does is not well understood. It effects the endocrine system, but not in consistent ways, and with some possibly serious side effects. It is being aggressively marketed as a way to stop hair loss, but may do various other things instead.
- scythe 1y agoThe paper mentions that finasteride passes through the blood-brain barrier and affects the conversion of progesterone to allopregnanolone, where low levels of allopregnanolone are associated with depression. Together with the correlational evidence for depression and suicidality, this presents a reasonable picture for concern. Since there is a known central activity, it also raises the question -- in fact the article explicitly mentions it -- of whether a brain-sparing analogue of finasteride might not show the same side effects. The apparent connection to "masculinity" or "feminization" may be a red herring. Excessive concern about "sex" effects in biological systems kind of reminds me of the alchemical theory of the four elements. It's not a great way to analyze the complicated effects of medicines.
- michaelmrose 1y ago> Concerns about depression from finasteride were raised in several studies as early as 2002. It seems clear to me that anything which has depression as a side effect has an increased risk of suicide as well and the only remaining truth to find is the degree. The executives and scientists should both be prosecuted.
- dinobones 1y agoI take dutasteride (even stronger form of finasteride) and have been personally fortunate to not have any side effects in ~8 years. My whole family on both sides is bald bald. Without it I would have been bald bald in my early 20s. I knew there were risks of hormone disruption/mood swings/etc but I still prefer it over being bald. I took a calculated risk and I'm thankful that the drug exists. Please don't prosecute the people that gave me the only real, working treatment for my baldness.
- chimeracoder 1y ago> I take dutasteride (even stronger form of finasteride) and have been personally fortunate to not have any side effects in ~8 years. Dutasteride is not a stronger version of finasteride. It's a more effective DHT blocker, but it works differently. The side effects are also different and not easy to predict. Some people have terrible side effects from finasteride and none from dutasteride. Some people have the opposite. And some people can tolerate either one. We don't have a way at the moment to reliably predict which one will work better or be better tolerated for a given individual. Anyway, I'm glad it has worked for you, and I also would not want to prosecute people who've created a medication that's one of the most effective and well-tolerated around.
- teitoklien 1y agoFinasteride every year changes millions of lives globally, I take finasteride, and it’s the sole reason i have my hair. Idk about you, but i know 10s of different friends who also went through hairloss and were struggling to stop it, who went through severe depression, loss of confidence, suicidal tendencies in extreme cases. Just because you saw a study that X drug causes side effects/harms in 1-0.1% of patients, doesnt mean the med should be taken off sale especially for a drug as important as finasteride. It’s easy for someone to say it’s just a cosmetic drug until they go through the full extent of social, mental, and even physical damage, hairloss at a young age causes. I and almost everyone who takes finasteride take it knowing the risk of a whole range of side effects , often far more severe then just increasing risk of depression. like risk of reduction in fertility, libido in some patients often struggling with obesity. Obesity creates a whole range of problems too, should we start prosecuting creators of tasty food too ? , fin 1mg is one of the most impactful drugs sold globally both under brand names and generic cheap drugs (i take a generic one) that is life changing for almost a quarter or more of men depending on the country who face male pattern baldness and its related issues. More studies certainly should be done in link of depression and suicide in some patient cases, but bringing out the pitchfork like luddites and asking to prosecute executives and scientists for a non-opiod, non-addictive, drug that’s been used safely for decades across generations, and saved families thousands of dollars (including mine) in snake oil salesman products that claim to treat hairloss but dont. They should get awards, not pitchforks.
- wizzwizz4 1y agoI'm shocked that this wasn't widely known in the US. Reports from trans people, way back in the 1940s, show clear links between sex hormones and depression: a priori, one would assume such a relationship would exist here. The article appears to allege a cover-up: > It is difficult to imagine what data could justify hiding in a drug safety review. I've been sceptical of any direct relationship between "post-finasteride syndrome" and sexual function, but I've never doubted the direct effect on mental health of suppressing dihydrotestosterone in cis men. (Even if the pharmacological effects end shortly after cessation, which I suspect, a sudden and unexplained strong feeling of constant wrongness can be traumatic.) The part I find interesting is that most men seem to be just fine with taking finasteride, even orally.
- chimeracoder 1y ago> Reports from trans people, way back in the 1940s, show clear links between sex hormones and depression: a priori, one would assume such a relationship. We have a lot of data about trans women taking finasteride as part of HRT and depression, and the clear correlation runs in the exact opposite direction from what this article is talking about.
- nemomarx 1y agoYou might expect trans women to react differently to lower T levels than cis men for various reasons
- _--__--__ 1y agoFin blocks the conversion of T to DHT, that rarely causes lower blood serum testosterone levels and can possibly even increase them depending on what else you've got going on hormonally.
- wizzwizz4 1y agoRight, but it's not the serum levels that matter: it's the agonistic effect on various receptors. (Most) hormones don't have direct chemical effects on the body. According to Wikipedia: > Relative to testosterone, DHT is considerably more potent as an agonist of the androgen receptor (AR).
- dinobones 1y agoNot kidding: What about suicides prevented from not going bald? To paint a fair image, this study should also compare suicide prevalence for bald people. ------- Results: Compared with the controls, an increased risk of suicide attempts was observed in patients with AA, with an adjusted hazard ratio of 6.28 (95% confidence interval, 4.47-8.81). Suicide risk remained significantly elevated in AA patients when stratified by underlying psychiatric disorders. The mean age of initial suicidal behaviors was also lower in patients with AA. Conclusions: Patients with AA had a significantly higher incidence of suicidal attempts than controls, regardless of concurrent psychiatric illness. Further studies are needed to elucidate the pathophysiology of the association between AA and suicidality. In addition, dermatologists should be aware of the increased suicidality of patients with AA. https://pubmed.ncbi.nlm.nih.gov/36921592/ https://pubmed.ncbi.nlm.nih.gov/36921592/ ---- Not enough time to size these in comparable numbers to this study, but would be really interesting. Is it a net positive (reduced risk) over just going bald?
- smallnix 1y agoAlopecia Areata ≠ Androgenetic Alopecia
- dinobones 1y agoThanks, I googled "bald suicide risk pubmed" and it was the first article I found. I can't find any with as clear-cut statistics for AA. I still think it applies though; the psychological effect of being bald probably doesn't care much about the underlying cause.
- hatefulmoron 1y agoThere's probably a difference in degree, however. Alopecia Areata is much more uncommon, while regular male pattern baldness is very common. There's also the fact that Alopecia Areata is actually more common in women, which I imagine exaggerates the distress compared to the more run of the mill MPB. I realize you didn't mean to use a study on Alopecia Areata, but the difference in degree could be quite large.
- awinter-py 1y agotopical or oral???
- wizzwizz4 1y agoI would expect oral to have more of an impact on mood, but this article does not say. Good catch!
- verteu 1y agoThe studies listed are all about oral finasteride.
- StrangeDoctor 1y agoCorrect. Additionally, topical is not FDA approved. While not necessary for research it adds typically unwanted complications to studies.
- deleted 1y ago[deleted]
- fourseventy 1y agoAnecdotal, but I took Finasteride and I had suicidal thoughts until I stopped the drug. Not recommended.
- deleted 1y ago[deleted]
- CjHuber 1y agoI‘m 24 and bald now. I never even considered taking finasteride. A 1% of getting permanent erectile dysfunction without known cause (PFS) nukes the expected value for me
- deleted 1y ago[deleted]
- BriggyDwiggs42 1y agoI started taking it when i noticed my hair going and ive had no problems while keeping the hair. I sorta think it’s worth a shot.
- InMice 1y agoYou rolled the dice and got out ok, perhaps just like any other drug technically. There is a small portion of people that will get irreversible damage from it and basically they have no real idea how to find them out first.
- BriggyDwiggs42 1y agoThat’s fair, but if you notice problems you can quickly stop and no longer have issues no?
- CjHuber 1y agoIf you could it would not be permanent right? https://www.pfsnetwork.org/ https://www.pfsnetwork.org/
- cyberax 1y agoMight be a good idea to switch to low-dose minoxidil? It seems to have very few side effects, and even then they are benign for most people (slightly lower blood pressure).
- groovy2shoes 1y agothe two drugs are complimentary and often prescribed together. finasteride is overwhelmingly well-tolerated, and i suspect that many reports of serious and lasting adverse reactions involve misattribution.
- lithocarpus 1y agoWhat's your basis for suspecting that?
- groovy2shoes 1y agopersistence of symptoms after discontinuation is the big one. after hormone levels return to baseline, there's no more pharmaceutical effect. thus the cause of those symptoms is unlikely to be pharmaceutical. it's worth noting that candidates for finasteride treatment are already likely to be older and dealing with comorbidities like depression and anxiety, which makes it harder to say for sure if it's the drug in a lot of cases, but they do seem slightly higher than placebo. it is not surprising that a sudden change in hormone levels would cause a noticeable change in mood or sexual function, but there is usually improvement with continued treatment as levels stabilize. for persistent effects, really there isn't a lot of reliable data to go on, and no plausible mechanism of action. we have a handful of anecdotal reports and some armchair hypotheses. i'm happy to be proven wrong, and lots of drugs are indeed implicated in serious and lasting side effects, but in the case of finasteride i'm not convinced.
- lithocarpus 1y agoGotcha, and that's fair to not be convinced. "after hormone levels return to baseline, there's no more pharmaceutical effect" Maybe no longer directly, but with one level of indirection there certainly _could_ be. "no plausible mechanism of action" - I haven't looked into it to understand the mechanism of action for side effects from finasteride, but certainly if it can cause side effects during use, those could impact the body in a way that causes effects that persist past when usage stops. Same with almost anything harmful that we do to our body - ideally the damage or effect is healed and we return to baseline, but very often we don't. There could also be an effect where someone tried it, it didn't work as well as they wanted or it caused a side effect, and this was psychologically difficult to deal with and helped lead to depression and anxiety without that being directly chemically caused by the drug. And it would be fair to argue that that's not the drug's fault.
- timr 1y agoThis is not a scientific paper. It is a "narrative review", which is another way of saying "editorial". It superficially looks like science, but doesn't do any of the methods, controls or (correct) statistics that you would expect in a legitimate meta-analysis. Do not take it seriously. The "dedication" at the top should clue readers into what is going on -- it's not even trying particularly hard to look legitimate -- but alas. Edit: this line, in particular, made me laugh. It is one of the more egregious examples of "pretending to do statistics" that I have seen recently: > Table 1 summarizes the studies in the last decade examining a potential link between neuropsychiatric reactions and finasteride exposure. When prescribed mainly for AGA, all reports suggest that finasteride can cause depression, anxiety, suicide ideation, and suicides. Assuming a null hypothesis (finasteride does not affect mood) and a 50% chance of 1 result against this hypothesis, the probability of getting all 8 studies concluding against the null hypothesis by chance is 0.58 = 0.0039.
- comrade1234 1y agoFrom your description it sounds like a review article? Which is common and normal. I haven't read it though because I'm not bald.
- timr 1y agoIt isn't a review article, though the difference is more subtle, because a review article is also editorial in nature. The difference here is that this article is someone with an axe to grind (again, see the "dedication", which is never done in a legitimate review; and the clownish application of statistics, which is so completely absurd that it implies incompetence, malice or both). I have no faith that this writer made a legitimate attempt to impartially weigh the evidence on this question.
- viking123 1y ago"Misery loves company" the paper
- azinman2 1y agoDoesn’t mean this isn’t correct. These problems are definitely real.
- zorobo 1y agoTried finasteride and my sleep quality was altered ; vivid nightmares and tremors in my legs that would wake me up. I stopped taking it and those disappeared. Fwiw.
- pembrook 1y agoA word of caution to anyone trying to take health advice from HN comments: don’t. Want to debate javascript frameworks and linux distros? sure, there’s great knowledge here. This is not the case for most topics outside of software. If you followed the health advice here you’d be living in a shed in Antarctica to avoid microplastics, taking shrooms for your mental health and rejecting all pharmaceuticals when you get an infection.
- rootusrootus 1y agoI would extend that to all topics, even the technical ones. The upside to HN is that it attracts a lot of smart, technically knowledgeable people. That's the downside, too. Everyone likes to think Dunning-Kruger is an indictment of over-confident stupid people, but I think it serves us better as a warning to people who think themselves smarter than average. Heck, especially when they are smarter than average.
- InMice 1y agoTrying finasteride was the worst thing I ever did to myself. Traumatic and horrible experience if you are in that small % of people that it will permanently damage and alter your body.
- wizzwizz4 1y agoWhat permanent damage and alterations have you noticed? I suspect these are all attributable to trauma, in which case psychotherapy might resolve them.
- InMice 1y agoNothing to do with psychotherapy. Plumbing, nerves, muscles, bodily functions - stuff like that completely disrupted and fucked up. is all I can say in this public context. Let me put this way: Assuming you only get 1 life on this earth, 1 body, one chance. You get certain bodily functions that basically work the same way from puberty into your older age assuming no other harm or accident. You are in mid adulthood you try a drug for a few months. you quit that drug because weird symptoms develop. shortly after stopping those symptoms magnify and then persist. you can classify the persistence in two categories (1) persistent irrevisble, my body worked this X or Y way in this or that category my entire life now it doesnt and hasnt for years. (2) slowly reversing with random waves of lingering symptoms. there is a small % of people that will get permanent issues from ssri similarly and for finasteride its a small % that get totally messed up. and i tried straterra (an ssri) once and had side effect that made me quit. read worse cases than mine but there is a subjectively persistent pushback that its all a delusional mental problem but if i knew you and talked to you in a secure setting and i can assure you this drug is exceptionally dangerous to a small % of people that try it and seems like we have no science and or data to tell who is at risk anywhere close reasonable safety.
- wizzwizz4 1y agoI think you underestimate the potential physiological effects of a traumatic experience, which is why I asked for the specific symptoms you experienced. If they're limited to those known to be caused by trauma, then that might be the mechanism by which the drug caused the problems (and it might be treatable). I do not believe that finasteride would cause permanent, untreatable problems – but if it does, then it does so by a completely unknown mechanism, and investigating that mechanism is extremely important to our understanding of the human body. If you would be willing to contact me privately about this, there are various ways for you to do so.
- anonymousiam 1y agoI took Finasteride (1mg) daily for 20 years, because both my GP and my wife had commented on my thinning hair. The pills worked, and I didn't have any side effects (that I can positively attribute). Five years ago, I was diagnosed with CKD (3A), so I stopped taking Finasteride, which was the only prescription drug I was taking. I cannot claim any causal relationship, but I have been happier for these past five years. Of course, it could be because I'm now retired and financially secure. My hair seems to be thinning again, but it's still there.
- anon373839 1y agoConcerns about Finasteride are dramatically overblown. It’s one of the most extensively studied and commonly prescribed medications for men. Side effects like these are comparable to placebo. They also conveniently happen to be the same types of effects that can be produced psychosomatically.
- AstroBen 1y agoIt's also extensively studied at 5x the dose people are talking about here. Men are prescribed 5mg for prostate enlargement. It's 1mg to treat hair loss
- ramon156 1y agoHello, I take finasteride for 4 years now. While a single case doesn't say much, I do think these arguments against finasteride are overblown. Without getting personal, finasteride didn't worsen my situation.
- _DeadFred_ 1y agoI took it, and knew nothing about these possible side effects. It was awful, and only when I looked it up did I find out the risks. This for a product advertised all the time. I have never had any other drugs/supplements/etc impact me like this. I'm kind of the 'feel no pain, don't pay attention to my body' type as well, so it was outside my comprehension this product could do this. People REALLY need to be warned better if they are going to push this on so many ads, and the process is setup in a way you don't really get the risk brought to your attention. Between these risks and the huge testosterone drop when taking it I don't understand how there is a market for this.
- tsoukase 1y agoFinasteride messes with the testosterone hormonal balance. As testo affects mood, no surprise it can cause depression (although relatively rare) and hence suicidality.
- mrguyorama 1y agoI am flabberghasted that some people choose to take an oral dose of this medication for hair loss. Why? The topical product is cheap and available and effective. Why choose to take a pill rather than directly target the affected area?
- bdangubic 1y agosee viagra :)