This is not a scientific paper. It is a "narrative review", which is another way of saying "editorial". It superficially looks like science, but doesn't do any of the methods, controls or (correct) statistics that you would expect in a legitimate meta-analysis. Do not take it seriously.
The "dedication" at the top should clue readers into what is going on -- it's not even trying particularly hard to look legitimate -- but alas.
Edit: this line, in particular, made me laugh. It is one of the more egregious examples of "pretending to do statistics" that I have seen recently:
> Table 1 summarizes the studies in the last decade examining a potential link between neuropsychiatric reactions and finasteride exposure. When prescribed mainly for AGA, all reports suggest that finasteride can cause depression, anxiety, suicide ideation, and suicides. Assuming a null hypothesis (finasteride does not affect mood) and a 50% chance of 1 result against this hypothesis, the probability of getting all 8 studies concluding against the null hypothesis by chance is 0.58 = 0.0039.
It isn't a review article, though the difference is more subtle, because a review article is also editorial in nature.
The difference here is that this article is someone with an axe to grind (again, see the "dedication", which is never done in a legitimate review; and the clownish application of statistics, which is so completely absurd that it implies incompetence, malice or both). I have no faith that this writer made a legitimate attempt to impartially weigh the evidence on this question.
A word of caution to anyone trying to take health advice from HN comments: don’t.
Want to debate javascript frameworks and linux distros? sure, there’s great knowledge here.
This is not the case for most topics outside of software.
If you followed the health advice here you’d be living in a shed in Antarctica to avoid microplastics, taking shrooms for your mental health and rejecting all pharmaceuticals when you get an infection.
I would extend that to all topics, even the technical ones. The upside to HN is that it attracts a lot of smart, technically knowledgeable people. That's the downside, too. Everyone likes to think Dunning-Kruger is an indictment of over-confident stupid people, but I think it serves us better as a warning to people who think themselves smarter than average. Heck, especially when they are smarter than average.
I‘m 24 and bald now. I never even considered taking finasteride. A 1% of getting permanent erectile dysfunction without known cause (PFS) nukes the expected value for me
You rolled the dice and got out ok, perhaps just like any other drug technically. There is a small portion of people that will get irreversible damage from it and basically they have no real idea how to find them out first.
Tried finasteride and my sleep quality was altered ; vivid nightmares and tremors in my legs that would wake me up.
I stopped taking it and those disappeared.
Fwiw.
Concerns about Finasteride are dramatically overblown. It’s one of the most extensively studied and commonly prescribed medications for men. Side effects like these are comparable to placebo. They also conveniently happen to be the same types of effects that can be produced psychosomatically.
It's also extensively studied at 5x the dose people are talking about here. Men are prescribed 5mg for prostate enlargement. It's 1mg to treat hair loss
I took Finasteride (1mg) daily for 20 years, because both my GP and my wife had commented on my thinning hair. The pills worked, and I didn't have any side effects (that I can positively attribute).
Five years ago, I was diagnosed with CKD (3A), so I stopped taking Finasteride, which was the only prescription drug I was taking. I cannot claim any causal relationship, but I have been happier for these past five years. Of course, it could be because I'm now retired and financially secure. My hair seems to be thinning again, but it's still there.
I'm shocked that this wasn't widely known in the US. Reports from trans people, way back in the 1940s, show clear links between sex hormones and depression: a priori, one would assume such a relationship would exist here. The article appears to allege a cover-up:
> It is difficult to imagine what data could justify hiding in a drug safety review.
I've been sceptical of any direct relationship between "post-finasteride syndrome" and sexual function, but I've never doubted the direct effect on mental health of suppressing dihydrotestosterone in cis men. (Even if the pharmacological effects end shortly after cessation, which I suspect, a sudden and unexplained strong feeling of constant wrongness can be traumatic.) The part I find interesting is that most men seem to be just fine with taking finasteride, even orally.
When I got it prescribed (in AU), my doctor told me he had many patients taking it with no side effects, and he also pointed out that the 1mg I was taking was much smaller than the 5mg some took for prostate enlargement. I also did some reading and never noted any links to depression. It just doesn't seem to always come up.
I think many men would also (naively) be happy to risk depression when confronted with impending hair loss. Ironically, maybe more happy chemicals are what's actually needed so we can feel like losing our hair is not the end of the world.
> Reports from trans people, way back in the 1940s, show clear links between sex hormones and depression: a priori, one would assume such a relationship.
We have a lot of data about trans women taking finasteride as part of HRT and depression, and the clear correlation runs in the exact opposite direction from what this article is talking about.
Many trans men who go on testosterone report reductions in suicidality. If the theory is that gender dysphoria related to hormonal incongruence causes depression, then the data from trans women taking the medication supports the theory that cis men might really struggle with it.
Readit News
The "dedication" at the top should clue readers into what is going on -- it's not even trying particularly hard to look legitimate -- but alas.
Edit: this line, in particular, made me laugh. It is one of the more egregious examples of "pretending to do statistics" that I have seen recently:
> Table 1 summarizes the studies in the last decade examining a potential link between neuropsychiatric reactions and finasteride exposure. When prescribed mainly for AGA, all reports suggest that finasteride can cause depression, anxiety, suicide ideation, and suicides. Assuming a null hypothesis (finasteride does not affect mood) and a 50% chance of 1 result against this hypothesis, the probability of getting all 8 studies concluding against the null hypothesis by chance is 0.58 = 0.0039.
The difference here is that this article is someone with an axe to grind (again, see the "dedication", which is never done in a legitimate review; and the clownish application of statistics, which is so completely absurd that it implies incompetence, malice or both). I have no faith that this writer made a legitimate attempt to impartially weigh the evidence on this question.
Maybe they are, maybe they aren't. Proof is required.
Deleted Comment
Want to debate javascript frameworks and linux distros? sure, there’s great knowledge here.
This is not the case for most topics outside of software.
If you followed the health advice here you’d be living in a shed in Antarctica to avoid microplastics, taking shrooms for your mental health and rejecting all pharmaceuticals when you get an infection.
Deleted Comment
Five years ago, I was diagnosed with CKD (3A), so I stopped taking Finasteride, which was the only prescription drug I was taking. I cannot claim any causal relationship, but I have been happier for these past five years. Of course, it could be because I'm now retired and financially secure. My hair seems to be thinning again, but it's still there.
> It is difficult to imagine what data could justify hiding in a drug safety review.
I've been sceptical of any direct relationship between "post-finasteride syndrome" and sexual function, but I've never doubted the direct effect on mental health of suppressing dihydrotestosterone in cis men. (Even if the pharmacological effects end shortly after cessation, which I suspect, a sudden and unexplained strong feeling of constant wrongness can be traumatic.) The part I find interesting is that most men seem to be just fine with taking finasteride, even orally.
I think many men would also (naively) be happy to risk depression when confronted with impending hair loss. Ironically, maybe more happy chemicals are what's actually needed so we can feel like losing our hair is not the end of the world.
We have a lot of data about trans women taking finasteride as part of HRT and depression, and the clear correlation runs in the exact opposite direction from what this article is talking about.