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Association of Depression with Finasteride Stratified by Dosage and Diagnosis: A Retrospective Cohort Study Using the TriNetX Database
Abstract

Association of Depression with Finasteride Stratified by Dosage and Diagnosis: A Retrospective Cohort Study Using the TriNetX Database

Caitlyn Curley, Dylan Wambold and Erum Ilyas
Journal of the American Academy of Dermatology, v 95(1), AB63
Jul 2026
DOI: https://doi.org/10.1016/j.jaad.2026.04.264

Abstract

Finasteride, a 5-α reductase inhibitor prescribed for androgenic alopecia (AGA) and benign prostatic hyperplasia (BPH), has been linked to psychiatric adverse effects, though large-scale evidence remains limited. This study evaluated risks of depression, suicidal ideation, and suicide attempts in male finasteride users compared to controls at 1-, 5-, and 10-years. We conducted a retrospective cohort analysis utilizing the TriNetX database Three cohorts were defined: (1) men with AGA prescribed 1 mg finasteride, (2) men with BPH prescribed 5 mg finasteride, and (3) controls without finasteride, AGA, or BPH. Cohorts were propensity-score matched 1:1 by age. Outcomes included incident diagnoses of depression, suicidal ideation, and suicide attempts at 1-, 5-, and 10-years. Risk ratios (RR) with 95% confidence intervals (CI) were calculated. AGA patients on finasteride 1 mg demonstrated decreased risk of depression (RR: 0.907; CI: 0.828-0.993; p=0.036) suicide ideation (0.586; 0.439-0.782; <0.0001) and suicide attempt (0.454; 0.215-0.959; 0.033). Conversely, BPH patients on 5mg finasteride demonstrated increased risks of depression (1.499; 1.476-1.523; <0.0001) suicide ideation (2.058; 1.938-2.188; <0.0001) and suicide attempt (1.378; 1.138-1.670; 0.001). AGA patients not on finasteride showed decreased risk of all three outcomes (p<0.0001) while BPH patients not on finasteride had increased risk (p<0.0001). These results contrast with case reports linking finasteride to suicidality in young men with AGA, suggesting such associations may not persist in large datasets. Psychiatric risks appear context-dependent: potentially protective in younger AGA patients but elevated in older BPH patients. Careful psychiatric monitoring and patient counseling are warranted, particularly at higher doses.

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