Medications Used for Male Pattern Baldness and BPH May Be Associated With Depression

5α-reductase inhibitors (5-ARIs) are a group of drugs that are used to treat enlarged prostate (benign prostatic hyperplasia, or BPH) and male pattern baldness/hair loss. Finasteride and dutasteride are the two main types of 5-ARIs.

These medications work by suppressing the enzyme 5α-reductase, an enzyme that helps convert testosterone into dihydrotestosterone (DHT). DHT plays a role in prostate growth, facial hair growth, and male pattern baldness. Suppressing the 5α-reductase enzyme decreases the amount of DHT the body produces, helping to shrink the prostate gland and reduce hair loss.

In recent years, there has been a heightened interest in the possible negative sexual, physical, and psychological side effects of 5-ARIs. For example, it is widely acknowledged that 5-ARI use may contribute to erectile dysfunction and low libido while men are taking the medications. Although controversial, some men report that sexual side effect persist even after stopping the drugs. However, the data available on the subject is limited, and very little is known about the potential association between 5-ARIs and dementia. 

Therefore, the authors of a recent study set out to examine the possible association of 5-ARIs with all-cause dementia, Alzheimer disease, vascular dementia, depression, and suicide. The study included 2,236,876 Swedish men who were between the ages of 50 to 90 years between July 1, 2005, and December 31, 2018.

Of the 2,236,876 men, 70,645 (3.2%) started finasteride treatment, and 8,774 (0.4%) started dutasteride treatment during this time period. The researchers found that the men who used 5-ARIs were at increased risk of all-cause dementia, Alzheimer disease, vascular dementia, and depression at the start of treatment with the medications.

Interestingly, the association between 5-ARIs and all-cause dementia, Alzheimer disease, and vascular dementia became statistically insignificant over 4 years of the individual using the 5-ARIs. On the other hand, the individual’s risk of depression remained constant over time, and it was increased with the use of 5-ARIs. There was no association found between 5-ARI use and suicide.

These findings indicate that this group of medications may increase a person’s risk of depression. Therefore, it is important for patients and health care providers to be aware of the possible side effects of these medications when considering them.

For more information on this topic, please read these publications from the ISSM Journals: The Journal of Sexual Medicine, Sexual Medicine Reviews, and Sexual Medicine Open Access.

• Persistent Sexual and Nonsexual Adverse Effects of Finasteride in Younger Men
• Differential Gene Expression in Post-Finasteride Syndrome Patients

References:

• Garcia-Argibay, M., Hiyoshi, A., Fall, K., & Montgomery, S. (2022). Association of 5α-Reductase Inhibitors With Dementia, Depression, and Suicide. JAMA Network Open, 5(12), e2248135-e2248135. https://jamanetwork.com/journals/jamanetworkopen/article-abstract/2799858