Under the brand names Propecia and Proscar, finasteride was at one time described as a breakthrough in the treatment of male pattern baldness and prostate. However, a 2025 Journal of Clinical Psychiatry review by Mayer Brezis, MD, MPH, suggests that there is a serious price of public health that may have been paid in terms of the benefits of the drug.
Although finasteride is prescribed as a cosmetic agent to alleviate hair loss, it has been observed over the years that this medicine has dramatic neuropsychiatric side effects, including depression and anxiety and suicidal behavior, which in some cases continues to manifest long after administration. Worryingly, authorities took over twenty years to realize these dangers putting millions of users at risk.
Evidence of Finasteride and depression and suicide.
The review summarises the evidence of eight large studies published between 2017 and 2024 that examined large health databases and adverse event reporting systems. The eight found a strong correlation of psychiatric adverse effects with the use of finasteride, especially when the therapeutic agent was used to treat androgenetic alopecia (AGA), which is a non life threatening cosmetic disorder.
Statistics showed a 57 percent greater threat of depression and a maximum three times rise in suicidal ideation in users.
Biological plausibility supports these findings: finasteride prevents the enzyme 5a reductase, and reduces neurosteroids such as allopregnanolone, which are involved in the regulation of mood and stress response. This neurosteroid imbalance is known to cause long lasting mood disorders even post drug discontinuance which is confirmed by animal and human studies.
The Human Toll: One of the Preventable Tragedies.
By projecting the world usage statistics, Brezis believes that hundreds of thousands of users have become depressed and hundreds to thousands have committed suicide in the past 20 years. These are not individual cases. The initial warning was in 2002, when physicians reported cases of depressive relapses that were directly associated with the re exposure to finasteride.
Although considerable evidence was building, the authorities in the field of health did not make the necessary prompt actions. The FDA of the U.S. did not consider depression as a side effect until 2011 and only ten years later, in 2022, suicidal ideation was added to the label.
This was soon after, in 2025 by the European Medicines Agency (EMA), years after lives had been lost.
How come that the danger was not noticed so long?
In this paper, a number of systematic failures that enabled the survival of this crisis are pointed out:
False Reporting of Suicidal Behavior.
Even the FDA own system of Adverse Event Reporting System (FAERS) noted only 18 suicides by 2011 where the statistical estimation was over 6,000-12,000 suicides in that same group of exposure.
Majority of suicides are not reported since families and doctors hardly associate them with a hair loss drug.
Manufacturer’s Negligence
Merck the initial producer of finasteride did not carry out the post marketing analysis studies despite initial indications. Data mining techniques were not used by the company in its data on drug safety even after it had proved their effectiveness in 2006.
Regulatory Inaction
The FDA and EMA did not timely request these studies, citing the lack of statistical power or only preferred newer drugs. Censored data, including whole sections of safety reviews that had been hidden to the public was found in internal documents in 2010.
This has lost trust of people in regulatory bodies due to this lack of transparency.
Biological Processes: The way that Finasteride influences the brain.
Finasteride disrupts neurosteroid production, depleting the quantities of substances that relax the neural activity and level the moods. The drug disrupted the hippocampal neurogenesis, enhanced neuroinflammation, and altered the gene expression of major depression in experimental models.
Some users complain of a set of chronic symptoms, termed post-finasteride syndrome (PFS), including emotional numbness, anxiety, cognitive fog, and sexual dysfunction, after discontinuation. This persistence over the long term makes the argument of biological causality as opposed to psychological or nocebo effects much stronger.
Ethical Issue: Cosmetic Good vs. Psychiatric Evil.
In the case of a cosmetic drug, any possibility of suicide is an unacceptable sacrifice. Although some may experience an increase in hair growth with finasteride, meta analyses indicate that most clinical trials were short term, small and industry funded and of moderate quality with risks of publication bias.
In the meantime, the social cost of depression, at an average of $24,000 per patient per year is much greater than the commercial benefits of the drug. The review also approximates a global economical cost of 4.8 billion dollars per year because of depression caused by finasteride, and that too, does not include human sufferings.
Reform Calls: What Has to Change.
The review ends with some urgent recommendations:
Withdraw marketing permission of finasteride as a cosmetic agent until new safety information can demonstrate the opposite.
Make a mandatory post approval safety surveillance and disclosure of findings to the public by all pharmaceutical manufacturers.
Requirement Mandatory documentation of medication history in any suicidal investigation to maintain accountability and prompt identification of warning signs.
Enhance the physician education regarding neuropsychiatric side effects to facilitate informed consent on behalf of the patient.
This is science and more than science, it is a question of morality and openness in the health of the people.
A Drug Safety Lesson of the Future.
The case of finasteride is a warning of the consequences of profit and bureaucracy over pharmacovigilance. The regulators and manufacturers have a role to play in ensuring that the so called safe medications are not unsafe once they get into the hands of millions of consumers.
In the case of young men who needed the use of cosmetic treatment to get a confidence boost, the threat of developing lifelong depression or committing suicide was not on the offer. Innovation is not exclusive in order to keep the health of the people in a state of public health. Honesty, vigilance and accountability are equally vital in this matter.
Conclusion
The Brezis analytical review 2025 brings a bitter truth that neuropsychiatric risks of finasteride could be predicted, spotted, and avoided.
The 20 year lag in the identification of these threats speaks to bigger malfunctions of the drug control and postmarketing surveillance.
The discourse should change, as the population ages, and it needs to be no longer about denial, no longer about cosmetic enhancement, no longer about reacting and controlling, but rather about acting in advance to safeguard the health of the populace.
Reference :
Brezis, M. (2025). Failing public health again? Analytical review of depression and suicidality from finasteride. The Journal of Clinical Psychiatry, 86(2), Article 25nr15862. https://doi.org/10.4088/JCP.25nr15862