It's also possible that people taking Finasteride might be a more potent selection of people that are distressed about hair loss, and are therefore more likely to exhibit depression, etc. As in, if people with androgenetic alopecia are more likely to be depressed, people who take finasteride may be a sampling of those people who are distressed enough to seek and maintain treatments.

Additionally, the kind of person who would reach for prescription medication vs accepting hair loss may be predisposed to depression. I.e. this may be selecting for people who struggle with self-acceptance generally.

I also wonder whether there's some degree of placebo going on. Patients know finasteride is anti-androgenic; perhaps when they inevitably experience some symptoms associated with hypogonadism they assume the worst and lament the choice between having hair and feeling youthful. This would also explain why many who get off finasteride don't notice their symptoms improve.

Personal bias: I've taken finasteride for years with no side effects.

This is exactly why people thought isotretinoin (brand name Accutane) caused suicides (and required huge hurdles to access for years). It turns out that people suffering from physical disfigurements, such as acne, are more prone to suicide than the general population. Not sure if this is also true of androgenetic alopecia but it would hardly be surprising.

This is completely false; the psychiatric effects of isotretinoin are well studied and significant, with a plausible mechanism of action no less.

Many people supposed that it’s just the acne making people depressed because it’s a nice plausible explanation, but it’s verifiably wrong.

I don't think we're saying different things. People who are distressed about their appearance are more likely to be depressed, and people who seek medicine and surgeries are probably more distressed still, and therefore more likely to be depressed, ..

We're not, I was agreeing with you

My mistake :-)

It did jump out at me that the paper repeatedly cites studies that found a correlation between finasteride and psychological side effects, and then talks about them as though they're evidence of causation.

The medicine has side-effects documented by users as well. There is PFS(post finesteride syndrome), I've never heard of Post Aspirine Syndrome.

Alopecia Areata ≠ Androgenetic Alopecia

Thanks, I googled "bald suicide risk pubmed" and it was the first article I found. I can't find any with as clear-cut statistics for AA.

I still think it applies though; the psychological effect of being bald probably doesn't care much about the underlying cause.

There's probably a difference in degree, however. Alopecia Areata is much more uncommon, while regular male pattern baldness is very common.

There's also the fact that Alopecia Areata is actually more common in women, which I imagine exaggerates the distress compared to the more run of the mill MPB.

I realize you didn't mean to use a study on Alopecia Areata, but the difference in degree could be quite large.

The amount of side-effects is correlated with how much people psyched themselves online before taking the medication.

I have been on it for 5 years but I didn't read stuff online about it before though so I didn't end up noceboing myself.

Does this research cover that? That was my first thought

If anything finasteride has improved my mental health. I've taken it for ~7 years with no negative side effects, and I'm certain it's the only reason I still have hair