We’ve been saying for some time that the known sexual side effects of Propecia are only a fraction of its real side effect profile. An ever increasing body of evidence reveals that finasteride (Propecia/Proscar)reliably causes a significant proportion of users bona fide psychiatric/ mental health problems, that were not pre-existing, and often persist long term after discontinuation.

Am J Mens Health. 2016 Feb 11. 
Emotional Consequences of Finasteride: Fool’s Gold.
Ganzer CA, Jacobs AR

Androgenetic alopecia, the gradual, progressive loss of hair frequently results in psychological despair, in part related to changes in self-image. Current androgenetic alopecia treatments are limited to hair transplantation and medications that inhibit dihydrotestosterone, a potent androgen associated with follicular micronization. Users of finasteride, which prevents dihydrotestosterone production, report serious physical and emotional adverse effects, collectively known as post-finasteride syndrome. Psychiatric illnesses and personality traits, specifically neuroticism influence emotional well-being. Limited research exists exploring the psychological corollaries of post-finasteride syndrome and preexisting Axis I and Axis II mental health conditions. The aim of this study was to explore how having a preexisting personal and/or familial history of a psychiatric diagnosis and certain personality traits may influence anxiety and depression among finasteride users. Participants in this online survey completed the Beck Depression Inventory, the Beck Anxiety Inventory, and Ten-Item Personality Inventory. An important finding in this study was that almost 57% (n = 97) of men reported a psychiatric diagnosis and 28% (n = 27) had a first-degree relative with a mental health disorder, of this group 17 only had a family history.Nearly 50% of the men surveyed reported clinically significant depression as evidenced by Beck Depression Inventory score and 34% experienced anxiety on the Beck Anxiety Inventory. There were no statistically significant trends in personality traits reported. Results provide evidence on the need to screen for psychiatric history and counseling patients about the potential psychological consequences of finasteride. Prescribing clinicians should carefully weigh the risk/benefit ratio with these patients.

      The data presented here are not only associative. There are specifically identified mechanisms identified in prior studies by which Propecia/Proscar can cause depression and anxiety. 

Propecia, Depression and Dementia

      If the aforementioned were not enough, finasteride also appears to cause male breast enlargement in a significant portion of users.

Propecia/Avodart grows more than hair

      There are, fortunately several ways to inhibit 5 alpha reductase and significantly lower DHT levels (the mechanism of finasteride) that are actually health promoting and side effect free:

Beyond Saw Palmetto: Natural Propecia Alternatives

      If you feel you must use finasteride, there exists a viable rationale (with strong anecdotal feedback) for using selected natural compounds that can be used singularly or in combination, to mitigate the associated sexual and mental health side effects. These are briefly: Optimized Resveratrol, Theaflavin Extract, Mega Green Tea Extract, Grape Seed Extract, Pomegranate Extract, and Pregnenolone.

      Resveratrol, Theaflavin Extract, Green Tea Extract, Grape Seed Extract, and Pomegranate Extract are all plant based inhibitors of aromatase, which have the effect of raising testosterone and concurrently reducing estrogen. Finasteride by itself will increase estrogen, which likely accounts for some of the reported sexual side effects, and male breast enlargement.

      Finasteride also down-regulates Pregnenolone, which is a naturally occurring hormone precursor that modulates the brains reaction to stress. Lowering Pregnenolone by using finasteride naturally makes one less able to adapt to stressors. Replacing Pregnenolone via supplementation has been reported by many to ameliorate some of the emotional side effects associated with finasteride. This makes sense given the identified mechanisms of action.