Persistent sexual dysfunction and depression in finasteride users for male pattern hair loss: a serious concern or red herring?

The 2014 document reviewed the potential adverse effects of finasteride, a drug used to treat male pattern hair loss. It highlighted concerns about possible irreversible sexual dysfunction and severe depression associated with the drug. However, the authors noted that these studies were significantly biased and called for larger, randomized, controlled trials to confirm these risks. A large study from 1992 involving 895 men found no reports of prolonged sexual side effects or depression, suggesting finasteride was generally well tolerated. However, 0.9% of users did experience persistent sexual side effects and depression. Other studies, including the PROSPECT study with 1,000 participants, reported increased sexual side effects in the finasteride group compared to placebo, but these often decreased over time. The Prostate Cancer Prevention Trial involving 17,313 participants concluded that finasteride's effect on sexual functioning was minimal. Reports of mood disturbances and depression were less common and often resolved after discontinuing the medication. Despite this, Sweden, the UK, and the US have updated product information to include possible persistent sexual side effects and depression. The authors concluded that finasteride is generally safe and well-tolerated, but further research is needed.