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The prescription DHT blocker finasteride has been found to increase the risk of suicidal thoughts by the European Medicines Agency (EMA)1. The EMA reviewed recent research and has confirmed that increased suicidal thoughts is a side effect of finasteride 1mg and 5mg tablets. Finasteride works by blocking the enzyme 5-alpha-reductase from converting testosterone to dihydrotestosterone (DHT). DHT is known to cause hair loss so the use of prescription DHT blockers helps lower the levels of DHT from causing hair loss. Aside from causing hair loss, DHT also has roles in the brain as a neurosteroid. It supports the development of the hippocampus which is the center for memory, spatial navigation, learning, and emotional processing. Do natural DHT blockers like saw palmetto have the same side effect? For natural DHT blockers like saw palmetto to have the same effect as prescription DHT blockers like finasteride and dutasteride, they would need to lower DHT levels in the blood and brain to be able to affect mood and emotions. One paper comparing the effects of finasteride and saw palmetto on DHT levels2 found several studies in which saw palmetto did not lower DHT in the blood (serum) compared to finasteride. While it is possible, it is unlikely that natural DHT blockers like saw palmetto will cause an increase in suicidal  thoughts. For saw palmetto to lower DHT levels in the brain, it would have to lower DHT levels in the blood. For it to lower DHT levels in the brain, it would also have to cross the blood-brain barrier. Sources: https://www.ema.europa.eu/en/news/measures-minimise-risk-suicidal-thoughts-finasteride-dutasteride-medicines https://silvershell.com.tr/wp-content/uploads/2022/08/Ref.-8.-Marks-et-al-2001.pdf

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