Disproportional signal of sexual dysfunction reports associated with finasteride use in young men with androgenetic alopecia: A pharmacovigilance analysis of VigiBase

To the Editor: In a recent study by our group, finasteride use was found to be associated with increased reporting of suicidality and depression in young patients with androgenetic alopecia.1 This previous analysis suggested that the association between finasteride and depression might be mediated by sexual dysfunction, which in men includes erectile dysfunction, diminished libido, and ejaculatory disorders. However, it is challenging to characterize the association between finasteride use and sexual dysfunction at the population level because of the underlying age-related comorbidities causing sexual dysfunction in older men with benign prostatic hyperplasia2 and possible nocebo phenomenon in which a negative outcome occurs because of expectations that an intervention will cause harm,3 among other factors.