What percentage of men experience depression with finasteride (Propecia)?

From the Guidelines

Approximately 1-5% of men experience depression with finasteride, with rates varying across studies from as low as 1.2% to as high as 4.9%. This variation in rates is evident in the studies provided, such as the PCPT 5 study, which reported a rate of depression in men taking finasteride, although the exact percentage is not specified in the provided text 1. Finasteride, commonly prescribed for male pattern baldness and benign prostatic hyperplasia, works by inhibiting the conversion of testosterone to dihydrotestosterone (DHT), which may influence neurotransmitter systems involved in mood regulation, potentially explaining the link to depression.

• The exact mechanism by which finasteride contributes to depression is not fully understood, but it is thought to be related to the hormonal changes caused by the medication.
• Some men report that these mood symptoms persist even after discontinuing the medication, a controversial condition sometimes called "post-finasteride syndrome."
• If you're taking finasteride and experience symptoms of depression such as persistent sadness, loss of interest in activities, changes in sleep or appetite, or thoughts of self-harm, it's essential to contact your healthcare provider immediately.
• They may recommend discontinuing finasteride and could suggest alternative treatments for hair loss or prostate issues that don't carry the same risk of mood changes, as seen in studies such as the PCPT 5 study 1.
• The treatment duration required for the best outcome with finasteride is not directly comparable to the question of depression rates, but it is worth noting that the PCPT 5 study, which is one of the most reliable trials for directly comparing the benefits and harms of finasteride, administered the medication for a planned 7 years 1.

From the Research

Finasteride and Depression

• The percentage of men experiencing depression with finasteride varies across studies.
• A study published in 2024 found that 1% of men with androgenetic alopecia (AGA) developed psychiatric disorders, including depression, after taking finasteride 2.
• Another study published in 2021 reported a crude pooled rate of depressive symptoms of 3.33% in men taking finasteride, compared to 2.54% in those not taking the medication 3.
• The same study found an odds ratio of 2.14 for depression in men taking finasteride, indicating a significant association between finasteride use and depression 3.
• A review of studies on finasteride and erectile dysfunction found that some studies reported a correlation between finasteride use and depression, but the evidence was not conclusive 4.

Comparison of Studies

• The studies varied in their findings, with some reporting a low rate of depression in men taking finasteride 2, while others found a significant association between finasteride use and depression 3.
• The differences in findings may be due to variations in study design, population, and dosage of finasteride.
• Further research is needed to fully understand the relationship between finasteride use and depression in men.

Limitations

• The available evidence is based on observational studies and systematic reviews, which may have limitations in terms of study design and bias.
• More research is needed to confirm the findings and to determine the mechanisms by which finasteride may contribute to depression in some men.
• Studies on finasteride and depression in men are limited, and more research is needed to fully understand the relationship between finasteride use and depression 5.