Use of 5α-reductase inhibitors (5-ARIs) for benign prostatic hyperplasia (BPH) and androgenic alopecia increases the risk for depression, but not suicide, according to a new population-based study. The risk for dementia observed at the start of treatment diminishes over time, indicating that other factors probably underlie this association.

In the Swedish national registry of 2,236,876 men aged 50 to 90 years, 70,645 (3.2%) initiated finasteride and 8774 (0.4%) initiated dutasteride. In adjusted analyses, finasteride and dutasteride users had a significant 22% and 10% increased risk of all-cause dementia, a 20% and 28% increased risk of Alzheimer disease, a 44% and 31% increased risk of vascular dementia, and a 61% and 68% increased risk of depression, respectively, compared with nonusers. While the risk for depression persisted, the risks of the other neurologic conditions diminished after 4 years, Miguel Garcia-Argibay, PhD, of Örebro University in Sweden, and colleagues reported in JAMA Network Open. At no point was 5-ARI use significantly associated with suicide.

“The statistically significant associations between 5-ARIs and depression are consistent with prior evidence and seem to emphasize the role of 5-AR in mood regulation,” Dr Garcia-Argibay’s team suggested. Prescribing clinicians and patients should be aware of the depression risk. The dementia findings may be due to increased detection.

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The investigators found significantly decreased risks for all-cause dementia over 4 years among men taking α-blockers, but significantly increased risk for vascular dementia, probably attributable to α-blockers’ hypertension indication.

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Garcia-Argibay M, Hiyoshi A, Fall K, Montgomery S. Association of 5α-reductase inhibitors with dementia, depression, and suicide. JAMA Netw Open. Published online December 22, 2022. doi:10.1001/jamanetworkopen.2022.48135