But behind its promise of thicker hair, a growing body of evidence shows that the drug may come with serious mental health risks, including depression, anxiety, and even suicide. Brezis describes this as a “systemic failure of pharmacovigilance”—a breakdown in how regulators track and respond to drug safety. None of the major safety studies cited in the review were done by Merck, the original manufacturer, or requested by regulators. The FDA took five years to respond to a citizen petition requesting a black-box warning. Brezis calls for major changes, including stopping marketing finasteride for cosmetic use until safety is re-established, requiring mandatory post-approval safety studies, and systematically recording drug histories in suicide cases.