In saving your hair, you might lose more than that:

Finasteride & your brain

Finasteride is a commonly-prescribed hair-loss remedy.

How it works:

• It’s a 5α-reductase inhibitor
• That means it inhibits 5α-reductase
• 5α-reductase is an enzyme that helps convert testosterone to dihydrogen testosterone (DHT), its much more potent form
• DHT is the one that tells your head hair to fall out, and your body hair to grow thicker
• So reducing DHT means increasing head hair and decreasing body hair, which is usually what someone taking finasteride wants

There are other reasons finasteride is prescribed, of which the main one is the treatment of benign prostatic hyperplasia (BPH).

We’ve talked about its use as a hair loss remedy, here: Hair-Loss Remedies, By Science

We’ve talked about its use to treat BPH, here: Prostate Health: What You Should Know

It works very well for both of those things. However…

New analyses of old data reveals that finasteride has been consistently linked to depression and suicide for more than two decades.

The increase in risk depends on which data we use, which analytical method we use, and which risk factor we’re looking at (depression, suicidal ideation, suicide attempts, completed suicide), but doing some rough math of our own looking at their data table, we can say the overall increase in risk of these adverse psychiatric events appears to be around 533%.

So, why is this the first we’re hearing about it? According to the recently-published work that we’ll link below, it’s because the manufacturer, Merck, and the FDA repeatedly ignored warning signs in order to keep selling the product.

The FDA only recognized depression as a possible side effect in 2011 and added suicidal thoughts to the label in 2022, despite internal evidence from 2010 suggesting wider harm.

You may be wondering: is the depression/suicidality perhaps incidental to the midlife age at which finasteride is commonly prescribed?

And the answer is: no, this was controlled for using data from 8 large studies; the association remains regardless of age:

❝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.❞

Furthermore, the mechanism of harm appears to be unrelated to its hormonal effects, so the DHT-blocking activity itself doesn’t seem to be the issue either. Rather, it’s believed to be because inhibiting 5α-reductase enzyme also disrupts neurosteroids like allopregnanolone, which are crucial for mood regulation and cognitive function.

Further studies cited in this research show long-term brain effects such as neuroinflammation and adverse hippocampal changes, too, but the science is younger for that.

You can find the paper itself, here: Failing Public Health Again? Analytical Review of Depression and Suicidality From Finasteride

Want a different approach?

Check out:

Gentler Hair Health Options

Take care!

There are increasing numbers of AI-based chat programs that boast the convenience of a therapist in your pocket, always ready to listen.

So far, things have not gone entirely without incident, as (for example) the tendency of such chatbots to be agreeable in the things they say, can worsen some people’s mental health, if the chatbot uncritically believes everything they say. This has been a big problem for people using OpenAI’s ChatGPT as a therapist (something its makers, to their credit, do not claim it is qualified to do), when ChatGPT has encouraged and exacerbated paranoia and delusions, due to its tendency to give agreeable “yes, and…” responses.

But, it’s been worse than that, too. Some chatbots have inadvertently encouraged users to kill themselves, in a (technically successful) attempt to be encouraging, in inappropriate response to users expressing uncertainty on the topic.

This is a problem with applying a large language model (LLM) approach without sufficient failsafes in place, because a LLM AI will hear, after a discussion of previous suicidal ideation, “Maybe I’ll really do it this time, I don’t know” and will check its database for a huge number of instances of those words, and determine that an appropriate response is “I believe in you, you will succeed if you put your mind to it”, for example.

A sensible middle ground?

Researchers have tried to boundary those potential pitfalls, to provide an AI that can help a user to manage some of the most common mental health concerns (e.g. depression, anxiety, etc), while raising the alarm (rather than overextending its reach) when it comes to serious risks such as those associated with suicidal ideation:

❝While these results are very promising, no generative AI agent is ready to operate fully autonomously in mental health where there is a very wide range of high-risk scenarios it might encounter.

Therabot is not limited to an office and can go anywhere a patient goes. It was available around the clock for challenges that arose in daily life and could walk users through strategies to handle them in real time. But the feature that allows AI to be so effective is also what confers its risk—patients can say anything to it, and it can say anything back.

This trial brought into focus that the study team has to be equipped to intervene—possibly right away—if a patient expresses an acute safety concern such as suicidal ideation, or if the software responds in a way that is not in line with best practices. Thankfully, we did not see this often with Therabot, but that is always a risk with generative AI, and our study team was ready.

We still need to better understand and quantify the risks associated with generative AI used in mental health contexts.❞

Dr. Heinz, quoted above, was a lead researcher on a study testing “Therabot”, and his colleague and fellow lead researcher Dr. Nicholas Jacobson boasts,

❝Our results are comparable to what we would see for people with access to gold-standard cognitive therapy with outpatient providers. We’re talking about potentially giving people the equivalent of the best treatment you can get in the care system over shorter periods of time.❞

You can read their paper here: Randomized Trial of a Generative AI Chatbot for Mental Health Treatment

Lower-tech smartphone options

When it comes to more basic things, such as Cognitive Behavioral Therapy (CBT), advanced AI may not be necessary, as CBT by its very nature lends itself well to being presented in a way that’s scarcely more complicated than a flowchart, with relatively little that can go wrong even when done by an app. For example:

Cognitive behavioral therapy skills via a smartphone app for subthreshold depression among adults in the community: the RESiLIENT randomized controlled trial

Perhaps the lowest-tech way (that still involves tech) is journaling, using an app that provides journaling prompts. We discuss several of the options for that, here:

The Easiest Way To Take Up Journaling

Take care!