Beyond the Follicle: Exploring Psychiatric Comorbidities in Androgenetic Alopecia

Abstract

    Androgenetic alopecia (AGA) is commonly treated with finasteride a 5-alpha-reductase inhibitor. Post-finasteride syndrome (PFS) is a constellation of neuropsychiatric and sexual adverse events following finasteride. Further complicating the formal diagnosis of PFS, baseline risk of psychiatric comorbidities in AGA remains unclear as the androgens responsible for AGA also play a key role in regulating mood, behavior, and neural plasticity. This systematic review characterizes the prevalence and types of psychiatric conditions in patients with AGA to contextualize potential vulnerability to PFS.

 Following PRISMA guidelines and PROSPERO registration, we conducted a systematic review of PubMed and Cochrane Library through February 2025 for studies reporting psychiatric comorbidities in AGA patients. Twenty-six studies met inclusion criteria, encompassing five psychiatric domains: anxiety/depression, schizophrenia or psychotic disorders, obsessive-compulsive traits, personality disorders, and general psychological distress.

Depression and anxiety were consistently elevated in AGA patients versus controls, with symptom severity correlating with alopecia extent. Depression was more prevalent in women (55%) than men (3%). Whereas men exhibited higher rates of anxiety (78%) and aggression (22%) compared to women 41% and 4%, respectively. Personality disorders were also more frequent in AGA, though causality and directionality remain uncertain. Data on schizophrenia and obsessive–compulsive traits were inconsistent.

Patients with AGA appear to have elevated baseline psychiatric vulnerability that may overlap with or predispose to PFS-like symptoms. Mental health screening prior to finasteride initiation may be beneficial. A personalized approach to AGA treatment is essential to optimize outcomes and minimize harm.