One study found a possible correlation between these 2 side effects, erectile dysfunction and depression. Dr. Irwig looked at 61 former finasteride users with persistent sexual side effects and found that 64% also suffered moderate to severe depression and 39% suffered suicidal thoughts. “One may lead to the other,” he acknowledges. But something else might also be at play to make finasteride users depressed. Animal studies have shown that in addition to permanently causing the penis to have less connective tissue, finasteride may also block production of mood-moderating neuroactive steroids in the brain. Dr. McMichael does not recommend Propecia for people who have struggled with mood disorders. “Those of us who are well-informed are continuing to use it and telling our patients what they need to know about the risks,” she says. Meanwhile, the highly publicized lawsuits and the $3 per pill price tag for Propecia appear to be cutting into sales. The 2013 availability of a generic form of the drug also had a negative impact on sales  figures. According to SEC filings, Propecia sales fell from $447 million in 2011 to $283 million in 2013 while sales of Proscar fell from $223 million to $183 million. Dr. Francis says most of her patients now opt for a combination of lasers and minoxidil or take saw palmetto supplements, which work similarly in the body. “People would rather opt for what they see as a less-risky approach,” says Dr. Francis. Christian, who has filed suit against Merck and hopes to see his day in court in 2016, thinks that avoiding Propecia is a wise choice. “Believe me,” he says. “It’s not worth the risk.” Lisa Marshall is a freelance health and medical science writer based in Lyons, Colorado. When she’s not writing, she’s running marathons or spending time with her 4 children.