Hair-loss drug finasteride repeatedly linked to depression and suicidal thoughts Digest
Finasteride is one of the most popular prescription drugs for male hair loss, but questions about its psychiatric safety have lingered for over two decades. A new review analyzed postmarketing data to determine whether the drug contributes to depression, anxiety, or suicidality, and to examine why these risks took so long to be recognized.
The analysis brought together eight independent human studies conducted over the last decade. Four used adverse event reporting systems from agencies such as the U.S. Food and Drug Administration (FDA) and the World Health Organization (WHO), and four used national health records from Canada, Sweden, France, and Israel. The studies addressed finasteride prescribed mainly for androgenetic alopecia, commonly called male pattern baldness.
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The results were strikingly consistent across all studies:
- Every study reported higher rates of depression, anxiety, self-harm, or suicide among finasteride users.
- FDA reports showed roughly three to five times more suicidal thoughts and up to nine times more completed suicides among users relative to the combined background reporting for all other medications in the database.
- Global data from the WHO's VigiBase found similar patterns, with up to a four-fold increase in reports of suicidal thinking or psychological distress.
- Large national datasets found that finasteride users had about 20 to 210 percent higher risks of depression or self-harm; an increased risk of completed suicide was detected only in the French study, and only in people with pre-existing mood disorders.
- Despite these signals, underreporting was severe. In a population of about 4.6 million finasteride users, the FDA received only 18 suicide reports by 2011 and 320 by 2024, compared with thousands that would be expected based on general population rates.
Finasteride blocks an enzyme called 5-alpha-reductase, which is needed to produce neurosteroids such as allopregnanolone that help regulate mood and stress. Reduced levels of these brain chemicals can alter nerve growth, inflammation, and gene activity, potentially leading to long-lasting depression and anxiety, even after the drug is stopped.
These findings reflect both a genuine safety signal and a systemic failure of drug oversight. Neither the manufacturer nor regulators conducted the necessary analyses when early warning signs appeared in the early 2000s. Depression was added to finasteride's safety label only in 2011, and suicide risk was formally acknowledged by U.S. regulators in 2022 and by the European Medicines Agency in 2025.
Overall, this suggests that finasteride can cause serious and sometimes even persistent psychiatric adverse effects, urging stricter postmarketing surveillance, systematic reporting of medication histories in suicide cases, and a reassessment of the risk-benefit balance for a drug used mainly for cosmetic purposes. Discover other approaches to reverse hair loss and graying in Aliquot #112.