You can also watch our video about this article on Youtube.
Hi everyone, and welcome back to Hair Loss Immersion. I’m Dr. Ghorbani, a plastic surgeon specializing in hair loss.
When it comes to finasteride, there’s a lot of fear and misinformation, especially about its potential side effects.
On social media, some people report feeling depression, anxiety, or even having suicidal thoughts while using finasteride. Others claim that these symptoms can persist for years after stopping the medication.
So, does finasteride really cause depression and anxiety? Let’s explore the facts.
What the Data Says
Finasteride has been used for over 40 years to treat prostate issues and hair loss. With decades of data, we know that:
- The overall incidence of side effects is relatively low, around 2%.
However, depression and mental health issues are already common in the general population. When people experience these symptoms while on finasteride, it’s easy to assume the drug is the cause.
Key Point: Many individuals who don’t take finasteride—or any medication—still deal with chronic stress, anxiety, and depression.
The Nocebo Effect
The nocebo effect occurs when negative expectations about a medication lead to perceived side effects, even if the medication isn’t responsible.
Consider this:
- In a study of 2,000 participants, half were given finasteride, and the other half received a placebo (sugar pill).
- Both groups were told they were taking finasteride.
Results:
- 1.8% of those on finasteride reported side effects.
- 1.3% of those on the placebo also reported similar side effects.
These numbers are remarkably close, indicating that belief and expectation play a significant role in perceived side effects.
Self-Experiments by Doctors:
Some doctors have conducted self-experiments, giving patients placebo pills labeled as finasteride. Many patients reported side effects like erectile dysfunction and depression, even though they were only taking sugar pills.
Can Finasteride Affect Mood?
From a scientific perspective, finasteride can potentially influence mood.
Here’s why:
- Crossing the Blood-Brain Barrier
Finasteride is known to cross the blood-brain barrier, meaning it can interact with the central nervous system and potentially affect cognitive functions and mood. - Animal and Human Studies
- In animal studies, finasteride has been linked to depressive symptoms.
- Some human studies have reported instances of depression and anxiety in a small number of patients.
- Hormonal Changes
Finasteride reduces DHT levels by around 72% and increases testosterone and estradiol levels by 15-20%.
Estradiol’s Role:
- Estradiol, though typically higher in women, plays an essential role in men’s sexual function and brain health.
- For active, fit individuals, increased estradiol can be beneficial.
- However, in inactive, obese, or hormonally imbalanced individuals, higher estradiol may cause:
- Loss of libido
- Erectile dysfunction
- Low motivation and mood changes
Who Should Avoid Finasteride?
While finasteride is generally well-tolerated, it’s not suitable for everyone.
Key considerations include:
- Mental Health History: Pre-existing anxiety or depression could make you more sensitive to mood changes.
- Obesity: Hormonal imbalances associated with obesity may increase the risk of side effects.
- Hormonal Conditions: Individuals with underlying hormonal issues may experience more pronounced effects.
Important: Depression is a clinical diagnosis made by a psychiatrist. Feeling down occasionally doesn’t necessarily mean you have major depressive disorder.
Customizing Your Finasteride Dose
For most people, 1 mg daily of finasteride is effective and well-tolerated.
However, if you experience side effects:
- Consider trying a customized dose to find the level that works best for your body.
- Lower doses can still provide significant benefits while minimizing side effects.
For more on this, check out my video on customized dosing.
Conclusion
While finasteride can cause mood changes in a small number of people, the majority tolerate it well without side effects. If you’re concerned about its impact on your mental health, consult your doctor for personalized advice and consider a customized dosing approach.