What should I ask patients before prescribing finasteride or dutasteride, and how should I monitor them for depression, suicidal ideation, or persistent sexual side effects?

For finasteride or dutasteride, keep the pre-prescribing screen focused on mood + sexual baseline, then safety-net clearly.

What to ask before prescribing

At minimum, ask:

• Any personal history of depression or suicidal thoughts/behaviour? This is the specific MHRA requirement before prescribing finasteride [1][2]
• Any current low mood, anxiety, anhedonia, self-harm or suicidal ideation? MHRA advises regular review for psychiatric adverse effects and the finasteride SPC says to monitor for psychiatric symptoms [2][3]
• Baseline sexual function: libido, erections, ejaculation, and whether any dysfunction is already present.
  This is my practical inference from the known sexual adverse-effect profile and the need to monitor for change. Finasteride and dutasteride are both associated with sexual dysfunction [1][2][3][4]
• Any fertility concerns / trying to conceive? Finasteride and dutasteride can affect semen characteristics; dutasteride SPC says reduced male fertility cannot be excluded [3][4]

How to monitor

MHRA says to review patients regularly for psychiatric and/or sexual side effects and to tell patients to involve family/friends because mood change may be noticed by others [2][1]

A practical monitoring approach:

• At each review, ask directly about:
  • low mood, loss of interest, anxiety, irritability, sleep change
  • suicidal thoughts, self-harm, hopelessness
  • libido, erectile function, ejaculation, and orgasm
• Document baseline and any change in sexual function and mood.
• Encourage patient/partner/family to watch for mood/behaviour change [1][2]

What to do if symptoms appear

• Finasteride 1 mg: stop immediately if depression or suicidal thoughts develop, and contact a clinician urgently [1][2]
• Finasteride 5 mg or dutasteride: contact a clinician as soon as possible if depression or suicidal thoughts develop [1][2]
• If any sexual dysfunction occurs or persists after stopping, advise review, document carefully, and report as an ADR; persistent sexual dysfunction has been reported with finasteride [1][2][3][4]
• If there is immediate risk of serious harm, MHRA advises emergency services [2]