5-α-reductase inhibitors and the risk of suicide and neuropsychiatric symptoms: a meta-analysis of observational studies

Following PRISMA guidance and a pre-registered protocol, the authors systematically reviewed observational studies of suicide and neuropsychiatric events (anxiety, depression, intentional self-harm) in 5-ARI users with prostate enlargement or hair loss. Eleven studies entered the systematic review and nine the meta-analysis, comparing users against non-users or alpha-blocker users. The pooled estimate showed no statistically significant association (HR ~1.07, wide confidence interval) with substantial heterogeneity across studies. The authors conclude the evidence does not support a class-level risk increase but call for continued active surveillance and prospective studies given regulatory concern.

The latest quantitative pooling of studies on finasteride-type drugs and mental-health risk. It finds the concern biologically plausible — depleted calming neurosteroids, direct brain effects and possible epigenetic vulnerability combining — and urges caution especially in younger users and those with psychiatric vulnerability.