5α-Reductase Isoenzymes: From Neurosteroid Biosynthesis to Neuropsychiatric Outcomes

This systematic review examines the role of 5α-reductase isoenzymes in neurosteroid biosynthesis and their implications for neuropsychiatric outcomes. It highlights that inhibitors like finasteride and dutasteride, used for conditions such as androgenetic alopecia, can lead to neuropsychiatric symptoms, including depression and anxiety, due to reduced neurosteroid synthesis. The review underscores the importance of genetic variability and individual susceptibility in these adverse effects, with evidence from large epidemiological studies suggesting an association between finasteride use and increased risk of depression and suicidal ideation, particularly in younger men. The findings emphasize the need for careful patient counseling, monitoring, and further research to advance personalized medicine approaches.