Temperament Change from Taking Propecia Reminds Me of Taking Antidepressants
I am now about five weeks into taking Propecia and think that it has affected my temperament. (It reminds me a bit of taking SSRI anti-depressants some time ago.) I little wish to lose my hair and will in a little while decide whether or not I continue with this medication which I gather takes about three months to have a noticeable effect.
What interests me is knowing whether or not this sex hormone pharmaceutical is more or less severe in its side-effects than the female contraceptive pill which it reminds me of (I am a medical layman) in its operation?
Hope that you do not mind a question from outside the United States!
There are mental side effects reported in a small group of individuals, much as you described. I’ve written about this many times before, including here, here, and here.
In one study, finasteride has been found to inhibit hippocampal neurogenesis in mice, which is related to emotional behavior. There are reports in humans with the higher dose (5mg) used to treat the prostate, and Wikipedia lists a few very tiny studies from at least 6-10 years ago that might point to a link between depression and finasteride in humans. This preliminary study from nearly 7 years ago suggests that patients with a high risk of depression should be prescribed finasteride with caution.
It seems like Dr. Rassman has spent a little bit of time getting educated (on Wikipedia) but has not kept up with the latest developments in finasteride’s mechanism of action. The Post Finasteride Syndrome Foundation has been working to gain a deeper understanding of exactly how finasteride is causing long-term side effects in its patients and it recently found a small group of men have persistently lowered neurosteroid levels as measured in their CSF. It is a small study of course, but its findings are significant and we will learn more about the long-term effects of finasteride on the body as more research is conducted. Just because hair loss surgeons are unaware of the risks of the drug does not mean they do not exist.
https://www.pfsfoundation.org/news/abstracts-from-february-2013-pfs-roundtable-research-discussion-in-italy/
The “post-finasteride syndrome†(with an accompanying foundation noted on a web site) is a term coined by lawyers involved in encouraging class action litigation and medical malpractice. As such, the site devoted to this ‘syndrome†is littered with anecdotes as well as references to review articles and uncontrolled, single center, poorly conducted studies. This includes the uncontrolled study reported in abstract form at a conference noted by the previous poster, which involves a “general†decrease of neuroactive steroid levels from the cerebrospinal fluid of 3 individuals with post-finasteride syndrome. This is not (to me) high quality science.
Personal experiences are important because they then often lead to properly done science, especially with medical conditions (pain, depression, headache, erectile dysfunction, etc) that have many causes and significant psychosocial contributants. The veracity of whether finasteride contributes to or causes depression will not be based on anecdotes, animal studies, uncontrolled studies, or internet searches. It will be based on well-controlled (easy to conduct) multicenter studies that are reported in the scientific literature in journal article form(ie PubMed, https://www.ncbi.nlm.nih.gov/pubmed).
Unsurprisingly, Biotech MD the self-admitted paid pharma consultant returns to attempt to discredit additional evidence that finasteride is dangerous. He is correct that the veracity of these side effects will be corroborated by controlled studies. This is an example of a controlled study. The sample size is small but will expand in the future. The results are very significant compared to the control group and will strengthen as the sample increases. But where he is wrong is that he continually downplays the difficulties with which this information is gathered. Few doctors are aware that neurosteroids exist in the human body, even fewer are aware of the implications of altering their levels, and even fewer again know how to conduct this complex studies.
It is also very difficult to find a subset of men who are willing to undergo a procedure to draw CSF since it is an extraordinarily unpleasant procedure that can be dangerous in itself. I am grateful to these men who took risks and faced discomfort so that we can further our scientific knowledge about the long-term risks of finasteride.