Planning to Quit to Reduce post Side Effects

General Discussion
#1

I only recently joined and will go do the new member stuff soon, but I plan to see my doctor tomorrow and want to discuss options.

I started taking Propecia I think around 2000 or 2001, but I am currently also suffereing from Depression, so my brain is not working great yet.

I was on the 1mg religiously and fell into Depression around Jan of this year, but didn’t get help until April. I ironically found out when searching and confirmed with diagnosis that I am also a long-term sufferer of ADHD (<7-years, long before Propecia) and so I got treatment for both with Adderall XR initially and then Wellbutrin XL added on and things seemed to be getting better.

I think I saw my hair growth accelerate around Dec/Jan and started adding about 1000mg of Saw Palmetto to my Propecia to help stop the deforestation. I did some research and found that it was likely that Adderall combined with Wellbutrin (which work synergistically) might very well be boosting my T production and thus DHT by extension. (not listed as side effect for either, only found it in “abuse” study)

I setup an appointment with my doctor for last Friday, and increased my Saw Palmetto for about 5-6 days to 6000-8000mg per day. So I convinced my Doctor to let me try Proscar to see if it helps, since all the original studies were with 5mg anyways.

2-days of depression and I stopped it yesterday. I looked online and in places like here…there was much debate about if suddenly stopping a Steroid (didn’t know it was one) taken for years might be ill advised since Body Builders don’t every do that and they do PCT to attempt to get a balance back.

I also noticed yesterday that I had Gynecomastia that I did not notice before, but not sure when it started. (never had before) So since everyone here said get a blood test before stopping, I restarted today at 1 mg and the Brain Fog and lethargic stuff has come back and my testes hurt today.

I don’t really want to wait until the blood test (Wed I hope) to stop. I also planned an extensive PCT stabilization plan after doing much research.

My Propecia PCT Recovery (and Gyn help) Plan

~When active plasma levels (based on half-life) drop below 0.01 (which was same as Placebo in orig studies) then do the following:

Wk1-4: Raloxifene(Evista) 60 mg once daily for 4-weeks.
Wk5: Exemestane(Aromasin) 12.5 mg/Raloxifene 40 mg per day.
Wk6: Exemestane(Aromasin) 25.0 mg/Raloxifene 20 mg per day.
Wk7: Exemestane(Aromasin) 25.0 mg alone per day.
Wk8: Exemestane(Aromasin) 12.0 mg alone per day.

~DONE…and move on I hope.

I checked the metabolics of everything and the two new ones will not interact directly with my original drugs which I am not quiting. (CYP450, CYPxxx stuff)

So based on no one having done any studies…does anyone have an opinion on the risks of Cold Turkey vs. this Post-fin PCT trial I created?

From what I have read and understood up to now…is that as long as I am not at too high doses and as long as I am not on it too long…it should hopefully help my HPTA restore the hormonal balance and prevent general endochrine shock or rebound.

Raloxifene(Evista) is a SERM with relatively low side effects/toxicity and better efficacy and Exemestane(Aromasin) is listed as a Aromatase Inhibitor, but is a permanent inactivator, which mostly reduce the increased estrogen level rebound effect. This is pretty close to how Exemestane is used with Tamoxifen with Breast Cancer in post-menopausal women.

So I have no ideas about whether or not I can do this, but that doesn’t change the discussion here. The question is do you quit (cold or ween) and then deal with issues or attempt to smooth out the ride and reduce any possible side-effects from the shock when you system adjusts it’s hormone levels back?

#2

Nobody has a definitive answer, since nobody can predict if you are destined to go back to normal anyway and remain that way after you quit (as it should be).

My suggestion would be – You might want to just come off and see how you do. If you experience the symtpoms listed on this site (penis starts shrinking, total loss of libido, major ED etc) after the initial “1.5-2 week” recovery (after DHT comes back), that might be the time to try PCT.

But I’d get bloodwork before PCT to confirm your T levels did in fact drop (if you are unlucky enough to experience this post-Fin) before commencing a cycle.

#3

I am not sure this makes sense, based on what some have said on here and a basic understanding of the endocrine mechanisms and the possible parallels with Anabolic Steroid users.

If my body currently has 10-20% elevated T levels and then we remove the anti-androgen and my DHT comes back…I would think that there would be an estrogen surge in response and then related effects. Body builders use PCT to prevent the side effects of estrogen rebound and get the hormonal balance closer to normal without the huge zig zag crashes that may risk damage to some systems too.

I will discuss with my doctor obviously, but I don’t really see why it shouldn’t be like getting off any other drug that has changed your biochemistry…they usually use some type of drug to minimize the crash effects on the body systems which is usually hard on the system.

Well I am going to suggest blood work regardless. I was originally thinking to wait until the blood tests came back before PCT, but I don’t see why we wouldn’t try to prevent the crash, not just try to mitigate it after the fact.

#4

Yes but remember – there are plenty of men who discontinue the drug that never have further issues, and they do not use any form of PCT. Their DHT returns and they carry on as normal.

We here are in a small minority in that we also had DHT return – only instead of continuing on as normal, T levels came crashing down shortly thereafter, ie within few days/weeks, and all the symptoms many men here continue to experience as a result – some despite having optimal hormone levels even, it seems.

The buildup of Estrogen occurs on the drug since Finasteride upregulates T production – T that would normally convert to DHT cannot since Finasteride is inhibiting DHT production – so the T aromatizes to Estradiol instead. Once you remove Fin, T and DHT levels are supposed to return to baseline, and E2 go down as a result.

In my opinion an estrogen “surge” would be unlikely after quitting the drug since Testosterone would be able to convert to DHT once again instead of aromatizing to E2. In addition, DHT is non-aromatizable and is an Estrogen antagonist, thus should work to keep E2 in check.

Good idea.

For the aforementions reasons – you may be just fine after quitting regardless, if you were destined to be, like so many other men. Either way it’s your choice – if you want to do PCT after quitting, thereby adding another hormone alterating drug/variable to the equation in trying to “ensure” that you will have no isses, that is your perogative.

Note that I don’t disagree with it, for all we know it could have helped us as well – but we’ll never know since we can’t turn back the clock to see if doing PCT would have prevented our post-Fin crash.

#5

Anything that is a permanent inactivator I would avoid if I were you, even if the manufacturer claims such inactivation would only occur “while on the drug”.

Estrogen does serve a purpose in men’s bodies, contrary to what some might think.

Arimidex (anastrozole) would probably be a better choice since it is an aromatase inhibitor, not a permanent inactivator.

Good luck.

#6

Well actually inhibitors that are not Suicide inhibitors aka inactivators will cause estrogen rebound since they suppress the hormonal system where an inactivator like this causes reduces in serum estrogen without affecting the system directly.

rxlist.com/cgi/generic/exemest_cp.htm

From above link:
Exemestane is an irreversible, steroidal aromatase inactivator, structurally related to the natural substrate androstenedione. It acts as a false substrate for the aromatase enzyme, and is processed to an intermediate that binds irreversibly to the active site of the enzyme causing its inactivation, an effect also known as suicide inhibition. Exemestane significantly lowers circulating estrogen concentrations in postmenopausal women, but has no detectable effect on adrenal biosynthesis of corticosteroids or aldosterone. Exemestane has no effect on other enzymes involved in the steroidogenic pathway up to a concentration at least 600 times higher than that inhibiting the aromatase enzyme.

I am thinking of trying nothing and just having my doctor monitor my blood levels as I agree to the general idea of why introduce something new, but I will ask for his opinion obviously.

#7

This seems to make sense, but does fly in the face of many of the comments on here. I am not a biologist or doctor and don’t know endocrinology that well.

I found this from their original patent application (maybe a tad bias):
“For instance, circulating concentrations of finasteride comparable to this Ki actually reduced levels of dihydrotestosterone to values approaching those found in individuals genetically deficient in the prostate isozyme, and as long as two weeks were required for dihydrotestosterone to return to basal levels after withdrawal of finasteride (Stoner, J. Steroid. Biochem. Molec. Biol. 37: 375-378 (1990) and Gormley et al., J. Clin. Endocrinol. Metabol. 70: 1136-1141 (1990)).”

So in theory or on average most men’s DHT levels should approach normal values in about 2-weeks (maybe 1-4 weeks including for more genetic metabolism variation…they rarely give the range)

I will get the blood tests tomorrow I hope and stay off the Propecia and ride it out. Besides apparently more Broccoli…any other suggestions to help with the hormone shift symptoms?

#8

I don’t know why he faught me on this, but he wouldn’t have them test for any estrogen or related hormones so that I could get a measure of the hormonal balance.

I said to him…well you know Gyno is normally caused by an imbalance of male/female hormones and if you don’t put any Estrogen related ones on there I will have no measure of it.

He’s like…only matters to women…your Gyno isn’t that bad, blah, blah, blah.

I was a little pissed at him…is he covering for the drug companies??? I have to pay for some of this testing besides the blood and the fasting and time and I don’t know why he wouldn’t indulge me after examining my Gyno. Anyone have an idea why he was against getting a measure of my hormonal balance while on fin. (well off for 1-day).

I just found a Self Learning booklet from his own College of Physicians that clearly says:

“The pathophysiology is believed to be an altered ratio between serum free estradiol and testosterone.”

I also tried to discuss the possibility of using a SERM like Tamoxifen or better Raloxifene(Evista) if it doesn’t clear up in like 3-months or so. And he was against it and admitted, but refused to accept the irony that having me on a long-term (4-yrs) low dose Anti-Androgen Steroid is similar to having me on something of the opposite in a short term to clear up the problems from the first drug that I never knew was a Steroid (not in drug company insert…not mentioned by Doctor)

He basically said that I was like the sucker born every minute and should live with the consequences or get surgery or lipo. I even asked him why he was okay with surgery, but against even considering endocrine treatment?!?! No answer.

Really pissed me off!!!

BTW: Same article (from 2004 that I am sure he never read) said the following:

“Tamoxifen appears to be successful, safe and avoids surgery. On present evidence, tamoxifen should be regarded as the first line treatment of gynecomastia.”

Fell free to read here(doc pg 16, search word gynecomastia):
http://www.cfpc.ca/local/files/CME/Selflearning/vol_19_1.pdf

I am thinking of getting it bound and then hitting him over the head with it literally in a few months if I still need help. Trust me…I don’t want to be on anything, but I don’t think I should suffer because the medical business (incl. him) lied or knowingly underplayed the risks with fin.

I am thinking of complaining to Health Canada…no Steroid should be allowed to be on the market and not call itself a steroid in it’s patient insert.

I hope I recover okay…hopefully in 2-weeks it will have cleared my system and my doctor conveniently covered up evidence of my hormonal ratio by refusing to test for any of the female ones. Well he did finally add prolactin, but that isn’t directly comparable as “serum free estradiol” is anyways.

#9

Doesn’t want to be held liable most likely.

See another doc, offer to pay for the tests yourself, get a requisition form and fill it in on your own. Or go to a local clinic and ask for a requisition form there.

There are materials on this site that corroborate Fin can cause gynecomastia due to altered androgen/estrogen balance from the drug, it is nothing new and Merck themselves acknowledge this fact due to potential for gyno in their drug insert.

Consider printing, highlighting relevant passages, and showing them to him. The materials are in these posts:
propeciahelp.com/forum/viewt … =7182#7182
propeciahelp.com/forum/viewt … =7203#7203

PS: where are you from in Canada?

PPS: where do you have proof that Finasteride is a steroid? Just curious (I have materials which claim the same but it is also used to mask Anabolic steroid abuse in athletes).

You should do this and have your doc file an adverse event report on your behalf. If he does not want to, then you know who’s side he’s on.

Or try reporting it yourself:
propeciahelp.com/forum/viewtopic.php?t=902

#10

Well I doubt I am going to do that right now. I am not trying to sue anyone at this point. I just wanted an accurate measure of my hormonal balance on fin to compare against for months later when my system should have recovered.

That’s what makes no sense about the liability concern. The patient insert off their website (not sure if it used to say this or not) says the following:

""In general use, the following have been reported: allergic reactions including rash, itching, hives and
swelling of the lips and face; problems with ejaculation; breast tenderness and enlargement; and
testicular pain. You should promptly report to your doctor any changes in your breasts…

And that’s exactly what I did and he seemed to be blaise about it which I found insulting and also dismissed my point that dealing with it before it became hard would be better than waiting until only surgery was an option. I wasn’t panicking about it…just trying to talk about assessment and treatment options. (though he blew away my on fin baseline hormonal balance blood test)

I also found out what I suspected. I specifically requested and had him send me for what I thought was a full blood work testing in Feb 2004 prior to starting fin so that I would have a baseline as I worried it might be too new a drug and knew it affected my hormones, but the risks were considered low and all was reversible. But he didn’t specify in my baseline blood work that ANY hormone levels be tested.

I was dumbfounded by this. I asked him wouldn’t it make sense to at least do a T level in the blood testing before starting the patient on an anti-androgen? (and esp. when the patient specifically asked for the blood work to assess his baseline health before the drug)

Southwestern Ontario

jcp.sagepub.com/cgi/content/abstract/33/10/967
merck.com/product/usa/pi_cir … cia_pi.pdf

Merck is tricky about it too and I never looked for this doctor level of info in 2004. It is tricky because they use a technical term to dance around it on the first page:

“PROPECIA (finasteride), a synthetic 4-azasteroid compound”

Hmm…you know a Synthetic Aza-Steroid sounds a lot like a Synthetic Steroid. I challenge you to find any references on their Patient info anywhere even on their website that even hints at this. They even in medical trials just call it an inhibitor and avoid the whole “steroid” term. I would guess it might heard sales as people normally would be more careful about trying a steroid.

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I will probably report it myself at some point. I don’t want to beat up on him much more. I was generally pissed at the entire medical community (incl. him) for not diagnosing my ADHD until I walked in at 36 and asked to be tested. They (his wife is his nurse) showed me today that my age and timing meant that it wasn’t diagnosed much when I was younger.

They are good people. He has been my doctor since I was like 4 years old. And unlike some GP’s usually if I bring in the information and discuss options with him…he is willing to try or consider things that many doc’s wouldn’t. I also have zero history of any drug abuse.

I didn’t really handle things the Dale Carnegie type way and didn’t think much about it, but many things I said could have been interpreted as “you didn’t tell me” or “you didn’t warn me”.

But I was mostly pissed at the drug companies for purposefully avoiding doing any study on longer-term side effects and/or diminishing the other ones. I really don’t know how depression didn’t make the list or how DHT’s effect on the brain was ignored.

Us Canadians are generally not a legally combative or sue friendly bunch. Our legal system is also designed to prevent frivolous lawsuits (loser pays winner’s legal fees) But we also normally have tougher regulation, esp. in Health. You can tell by how many new drugs advertised on TV in the states are not even close to being allowed on the Canadian market.

#11

Well maybe they did the study sometimes, but never had it published:
thelastpsychiatrist.com/2008/01/ … _nega.html

#12

Day2 off Propecia:

Well I don’t know what else to call it at this point. But besides fasting for 12-hours before the blood tests this morning…nothing else changed since yesterday.

Basically I noticed when I sat down at the clinic and thought maybe it was just the hard chairs, but on my pretty good work chair…it hurts on my Gluteous Maximum when I am seated. So technically I would guess this is muscle pain, I never really saw any actual listings of captured symptoms here of just the during the initial withdrawal.

Anyone else had this?

Seem far too much of a coincidence to have just started today. There is still much debate on here about weening vs. Cold Turkey on here. I did the math on the half-life and theoretical continuous serum levels of fin. With a conservative 8-hr half life…it comes out pretty quick anyways, but I am not sure how the rest of the endocrine system responds. I tried to ween, but first day trying 1 mg after my 5mg Depression Day and a break day was intolerable in terms of mental fog.

On the plus side my mind seems generally clearer, but I think I am a tad effected by the 5-vials of blood they pulled this morning and the fasting.

#13

Hi,

Please post your complete member story in the Member’s Story section… will be easier to track updates/progress there… I will move the Day 2 update to your post once you have done so. Thanks!