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.
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, ..
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.
