Propecia Sexual Side Effects Put Men at Risk for Depression

A new, retrospective, study reveals that Propecia, the popular hair loss medication, puts men at risk for depression.

Propecia (finasteride 1 mg) belongs to a class of drugs known as 5-alpha reductase inhibitors, or 5-ARIs. Propecia is approved to treat male pattern baldness and works by preventing the conversion of androgen testosterone to DHT, a hormone critical to male sexual performance. In April, the U.S. Food & Drug Administration (FDA) ordered new warnings for the Propecia label detailing possible long-lasting male sexual side effects associated with the drugs.

We recently wrote that another new study reported that sexual side effects that sometimes accompany Propecia use could be long lasting. Propecia sexual side effects often include erectile dysfunction, low libido, trouble having an orgasm, and shrinking and painful genitals. As we reported previously, Merck changed the Propecia label in Europe several years ago to warn that the drug could lead to permanent erectile dysfunction. Until the FDA ordered the April label change, warnings provided to U.S. users of the drug suggested that these problems typically resolve.

Now, it seems, that younger men who had taken Propecia and experienced its sexual side effects were also diagnosed with high rates of depressive symptoms; this, even after stopping the medication, said MedPageToday. About 75 percent of the men who suffered from persistent sexual dysfunction—for at least three months after stopping Propecia—reported depression symptoms, versus 10 percent in the control group who never took the drug, Dr. Michael Irwig of George Washington University in Washington, D.C., told MedPageToday. Symptoms were deemed moderate-to-severe in 64 percent of former Propecia user group; none in the control group, said Irwig. The study appears the Journal of Clinical Psychiatry.

The former Propecia user group consisted of a cohort of 61 men and 29 with hair loss, but no Propecia exposure or psychiatric conditions comprised the control group, said MedPageToday. About 39 percent of the former Propecia users reported thoughts of suicide; five percent agreed with the statement, “I would like to kill myself.” Only one in the control group reported having suicidal thoughts.

MedPageToday noted that the potential depression-sexual dysfunction connection is further complicated by the potential that either one can lead to the other. Apparently, Propecia can cross the blood-brain barrier, blocking enzyme action in the brain that changes hormone-derived neuroactive steroid levels, including a metabolite that can bind to receptors for the gamma-aminobutyric acid (GABA) neurotransmitter system. This, explained MedPageToday, has been implicated in anxiety and depression. “Although the effects of [Propecia] in the human brain are poorly understood, clinicians, as well as potential [Propecia] users, should be aware of the serious potential risks of this medication, especially as it is being used cosmetically to alter a normal age-related process,” Irwig concluded.

A number of men throughout the U.S. have filed lawsuits alleging Propecia caused them to suffer long-lasting sexual problems. The U.S. Judicial Panel on Multidistrict Litigation ordered the consolidation of federal Propecia lawsuits in the Eastern District of New York via an order dated April 16. A number of claims have also been filed in New Jersey state court and, in March, the Supreme Court of New Jersey centralized all complaints filed in the state before Superior Court Judge Jessica R. Mayer in Middlesex County, but declined to designate the Propecia litigation as a mass tort.

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