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5-alpha-reductase inhibitors show no statistically significant association with suicide or neuropsychiatric events in BPH or AGATrial shows 5-alpha-reductase inhibitors do not increase suicide risk

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Key Takeaway
Note that 5-alpha-reductase inhibitors are not associated with a significant risk of suicide or neuropsychiatric events.

This meta-analysis synthesized observational data to evaluate the safety profile of 5-alpha-reductase inhibitors (5-ARIs) in patients diagnosed with benign prostatic hyperplasia (BPH) or androgenetic alopecia (AGA). The primary objective was to determine if 5-ARIs are associated with an increased risk of suicide or neuropsychiatric events, including anxiety and depression, when compared to non-users or alpha-blocker users.

The analysis reported no statistically significant differences in the risk of suicide or neuropsychiatric events, with a reported hazard ratio of 1.07 (95% CI: 0.76 to 1.51). These findings suggest that 5-ARIs do not significantly increase the risk of suicidal ideation, anxiety, or intentional self-harm in these patient populations.

Authors noted substantial heterogeneity across the included studies (I2 = 59%). Because the underlying data are from observational studies, no direct causation can be inferred. Clinical practice remains focused on the safety of 5-ARIs, and while no significant association was found, continued real-world monitoring of patients for neuropsychiatric events is warranted.

How this fits prior evidence

This meta-analysis addresses a gap in the safety profile of 5-alpha-reductase inhibitors for patients with BPH and AGA. While previous coverage noted that 5-alpha-reductase inhibitors are associated with a reduced risk of incidental prostate cancer in surgical patients, this study specifically addresses the risk of suicide and neuropsychiatric events. The finding of no statistically significant difference in suicide risk (HR 1.07, 95% CI: 0.76 to 1.51) provides a specific safety profile for these medications.

Researchers looked at the safety of 5-alpha-reductase inhibitors, which are medications used to treat an enlarged prostate and hair loss. They specifically looked for links between these drugs and mental health issues like suicide, anxiety, and depression. The study compared people taking these medications to those who did not take them or used different types of medication.

The analysis found no statistically significant difference in the risk of suicide or other neuropsychiatric events for patients taking 5-alpha-reductase inhibitors. While these medications are sometimes associated with concerns regarding mood, this specific review did not find a significant link to self-harm or depression in the studied groups.

Because this was a review of observational studies, the results do not prove that the drugs cause specific outcomes. There was also a lot of variation between the different studies included in the analysis. Patients should continue to talk with their doctors about how they feel while taking these medications.

What this means for you:
No significant link was found between 5-alpha-reductase inhibitors and increased risk of suicide or depression.

Common questions

Are 5-alpha-reductase inhibitors safe for mental health?

The study found no statistically significant differences in the risk of suicide, anxiety, or depression for people taking 5-alpha-reductase inhibitors for hair loss or prostate issues. While these medications are sometimes monitored for neuropsychiatric events, this specific analysis did not find a significant link to these conditions.

Who is this finding relevant for?

This finding is relevant for individuals diagnosed with benign prostatic hyperplasia (BPH) or androgenetic alopecia (AGA) who are considering or currently taking 5-alpha-reductase inhibitors. The data suggests these patients do not have a higher risk of suicide or depression compared to other groups in this study.

Why is there still a need for monitoring?

Because this study was a meta-analysis of observational data, it cannot prove a direct cause. There was also significant variation between the studies included. Therefore, doctors recommend continued real-world monitoring to ensure patient safety and well-being while on these medications.

Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedOct 2026
View Original Abstract ↓
Introduction5-alpha-reductase inhibitors (5-ARIs), such as finasteride and dutasteride, are effective in reducing prostate volume and urinary symptoms; however, these drugs are associated with specific adverse events, including suicidal ideation, anxiety, and self-harm.MethodsA systematic review and meta-analysis of observational studies was conducted in PubMed, Embase and Web of Science on July 16, 2025, with no time restrictions. Studies involved individuals diagnosed with benign prostatic hyperplasia (BPH) or androgenetic alopecia (AGA), and experiencing suicide and neuropsychiatric events, including anxiety, depression and intentional self-harm (ISH) during the treatment with 5-ARIs. This study followed the PRISMA statement.ResultsEleven studies were included in the systematic review, of which nine were eligible for meta-analysis. Comparisons included 5-ARI users versus non-users or alpha-blocker users. Overall, no statistically significant differences were observed between groups (HR 1.07, 95% CI: 0.76–1.51), with substantial heterogeneity across studies (I² = 59%).ConclusionThis meta-analysis found no significant association between 5-ARIs and the risk of suicide or neuropsychiatric events in patients with benign prostatic hyperplasia or androgenetic alopecia. Nevertheless, given regulatory concerns regarding suicidal ideation, continued real-world monitoring through active surveillance and prospective observational studies remain warranted.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD420251106035, identifier CRD420251106035.
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