What Is Finasteride and How Does It Work?
Finasteride is a medication used to treat benign prostatic hyperplasia (BPH), which is an enlargement of the prostate gland, and androgenic alopecia (male pattern hair loss). It works by inhibiting the enzyme 5α-reductase (5-AR), which converts testosterone into dihydrotestosterone (DHT). Lowering DHT levels can help reduce prostate size and hair loss.
What Are the Potential Side Effects of Finasteride?
While finasteride is effective for its intended uses, it has been associated with various side effects, particularly psychiatric and sexual dysfunction.
What Are the Psychiatric Side Effects of Finasteride?
Suicidality and Depression:
A study using VigiBase, the World Health Organization’s global database, found a disproportional signal of suicidality, depression, and anxiety associated with finasteride use for alopecia in patients younger than 45 years.
The UK’s MHRA received 281 reports of finasteride causing depressed mood disorders, suicidal thoughts, and self-injurious behaviours up until April 2024.
What Are the Sexual Side Effects of Finasteride?
Persistent Sexual Dysfunction:
The MHRA has recorded 426 reports of sexual dysfunction, including erectile dysfunction and decreased sex drive, with finasteride use. Nearly half of these cases remained unresolved even after discontinuation of the drug.
50% of the men who reported sexual dysfunction while using finasteride said their symptoms did not go away even after stopping the medication.
Recommendations for Healthcare Professionals
Healthcare professionals should consider the following when prescribing finasteride:
- Screening for Mental Health: Before starting treatment, assess if the patient has a history of depression or suicidal thoughts.
- Monitoring: Regularly monitor patients for psychiatric and sexual side effects.
- Patient Education: Inform patients about the potential side effects and advise them to report any new symptoms immediately.
- Discontinuation Advice:
- For alopecia (1mg finasteride): Advise stopping the medication immediately if depression or suicidal thoughts occur and to seek medical help.
- For BPH (5mg finasteride): Recommend consulting a doctor promptly if psychiatric symptoms develop.
Advice for Patients
Patients should be aware of the following guidelines while taking finasteride:
- Report Any Changes: If you experience depression, suicidal thoughts, or any sexual dysfunction, contact your doctor immediately.
- Inform Your Doctor: Disclose any history of depression or suicidal thoughts before starting finasteride.
- Family and Friends: Let them know you are taking finasteride, as they might notice changes in your mood or behaviour that you do not.
Words of Wisdom from a Consultant Urologist
The decision to use finasteride should be based on a thorough understanding of its potential risks and benefits. While it is effective for BPH and alopecia, awareness and monitoring of its side effects can ensure better patient outcomes. If you feel your mood has changed speak up.