.png?v=1667978305)
For years, most of us would prescribe finasteride (Propecia) without hesitation. “Its actions are limited to the prostate and hair follicles,” we’d say, “and any side effects melt away once you stop.”
Then, little by little, patients—fresh from late-night Google rabbit holes—began asking about lingering sexual dysfunction, gynecomastia, mood swings, even “brain fog.” Again, many of us reassured the patient and politely suggested they may want to spend less time researching what seemed like "medication conspiracy theories" on TikTok.
Except now, a growing body of evidence is suggesting that those early patient concerns may not have been so far-fetched after all.
What Changed?
The European Medicines Agency (EMA), Health Canada, and the UK’s drug safety authority have all recently confirmed what we used to dismiss: finasteride — especially the 1 mg dose for hair loss — can, in rare cases, trigger depression and even suicidal thoughts.
In May 2025, EMA concluded a multi-year review and officially acknowledged suicidal ideation as a side effect of finasteride, citing over 300 suspected cases — mostly among younger patients taking it for alopecia.¹
Health Canada updated its product monograph in 2023 to include warnings about “depression, self-harm, and suicidal ideation, sometimes persisting after discontinuation.²
The UK’s MHRA issued a 2024 update urging prescribers to screen patients for depression and discontinue treatment immediately if symptoms arise.³
Let that sink in: a drug that’s been on the market since the 1990s, widely used by younger men with no psychiatric history, is now finally being linked to severe mood-related side effects.
The Signals Were There — Just Not Where We Were Looking
Earlier research zeroed in on older men taking 5 mg for BPH and found no suicide signal.⁴ Newer data flipped the script: younger men on the 1 mg hair-loss dose showed a clear link.⁵ Why? Because the population—and the stakes—were different.
A 2021 analysis of the WHO's global adverse event database found a clear link between finasteride and suicidality in men under 45 — particularly those taking it for hair loss⁵. It even showed that other hair-loss drugs, like minoxidil, did not have the same psychiatric associations.
Meanwhile, data from the FDA’s adverse event system showed that reports of depression and suicidal thoughts started climbing significantly after 2012, coinciding with rising awareness of post-finasteride syndrome.⁶
The Bigger Lesson
This isn’t just about finasteride. This is about how we, as healthcare providers, respond to patient-reported symptoms that don’t line up with what the package insert or initial trials say. Persistent sexual dysfunction after stopping the drug? Cognitive fog? Suicidal ideation in a healthy 27-year-old?
It sounded strange. But the longer we’ve listened — the harder it is to ignore.
One 2020 study looking at over 3,000 side effect reports found that 89% were psychological — things like depression, anxiety, and suicidal ideation. And those using finasteride for hair loss (vs. prostate issues) had about four times the odds of reporting mood changes.⁷
This scenario isn’t an isolated anomaly; we’ve seen similar post-marketing surprises with medications like minocycline, Protopic, Picato, and Mirvaso.
Where Finasteride Stands Now
- EMA: requires patient alert cards and new labeling.¹
- Health Canada / MHRA: added stronger boxed warnings.² ³
- FDA: now flags mood symptoms even from topical compounded versions.⁸
Final Thought
Finasteride is not inherently dangerous; for the vast majority of patients it provides clear benefit with minimal risk.
Beyond finasteride, though, the larger lesson is one of humility: medical evidence evolves, and today’s certainty can become tomorrow’s blind spot when new data emerges.
How about another perspective — imagine the patient who develops a rare but serious side effect and is now weighing legal action against the prescriber. Who do you think would be more likely to face a lawsuit?
- The clinician who listened, acknowledged the evolving nature of post-marketing medication use, and encouraged them to “stop the medication if symptoms persist,” or
- The one who rolled their eyes and recommended the patient to “spend less time on TikTok”?
Staying curious and receptive never diminishes our professionalism. Empathetic listening not only keeps patients safer, but can also protect us from the clinical—and legal—embarrassment of brushing off concerns which later prove to be wellfounded.
References
1. European Medicines Agency. PRAC Recommendations on Signal – Finasteride and Suicidal Ideation. May 2025.
2. Health Canada. Finasteride Product Monograph – Psychiatric Adverse Reactions Update. 2023.
3. Medicines and Healthcare products Regulatory Agency (UK). Drug Safety Update: Finasteride and Risk of Depression and Suicidal Thoughts. April 2024.
4. Welk B et al. 5α-Reductase Inhibitors and Suicide Risk in Older Men: A Cohort Study. JAMA Internal Medicine. 2017.
5. Nguyen DD et al. Adverse Event Reporting of Suicidal Ideation with Finasteride in Younger Men: An Analysis of WHO VigiBase. JAMA Dermatology. 2021.
6. Gupta AK et al. Increased Reports of Depression and Suicidal Ideation with Finasteride: An FDA FAERS Analysis 2013–2023. Journal of Cosmetic Dermatology. 2025.
7. Ali SI et al. Psychologic Adverse Events among 3,000 Finasteride Users: A Post-Marketing Review. 2020.
8. U.S. Food and Drug Administration. Safety Alert: Compounded Topical Finasteride and Serious Adverse Events. April 2025.