Finasteride increasing Cortisol levels?

[Thickandthin]

This is a bit of a stretch, but I have a reason to believe I may have chronically elevated cortisol levels.

Not Propecia related per se, but I'm afraid it might be exacerbating the problem. I did a random google search of "Propecia+Cortisol", and the only relevant results I got directed me back to this forum in posts by Mew and person. I believe Mew posted a study about finasteride causing similar side effects to a cortiocosteroid?

Has anyone else heard of this happening? The reason I ask is that I am mildly symptomatic for Cushing's, or at the very least just elevated cortisol and don't want finasteride to make it worse.

 

[Mew]

but I have a reason to believe I may have chronically elevated cortisol levels.

What reason do you have to believe this? Do you have de facto bloodwork or 24 urine profile before/after taking finasteride that shows a major difference in cortisol excretion?

I believe Mew posted a study about finasteride causing similar side effects to a cortiocosteroid

Are these the studies you were mentioning?


http://www.bio.unipd.it/bam/PDF/14-2/pr ... ngress.pdf
Search for Finasteride in the PDF.

"The current case confirms rapidly reversible myopathy as a possible adverse effect of finasteride treatment, attributable to its structural affinity to corticosteroids. "


http://171.66.120.158/cgi/reprint/38/3/285b

"However, the manufacturers [Merck] state that there are no reports of induction of the P450 system, and finasteride has no effect on the serum levels of adrenal steroids. "


http://jcem.endojournals.org/cgi/content/full/84/4/1304

The administration of finasteride has been associated with a decrease in DHT plasma values (7, 8, 10) and an increase in T levels (7, 8, 9, 10, 31); moreover, our data showed a decrease in DHAS levels, suggesting a slight inhibitory effect on adrenal steroidogenesis

The reason I ask is that I am mildly symptomatic for Cushing's, or at the very least just elevated cortisol and don't want finasteride to make it worse.

Are you saying you have been diagnosed with a mild form of Cushing's disease and are considering taking Finasteride, or you have been taking Finasteride and have been given a diagnosis of mild Cushing's?

 

[Thickandthin]

No diagnosis.

Possible elevated cortisol levels before finasteride usage.....but since I'm a hypochondriac I googled the two terms and found your posts. Now slightly wary of it worsening the situation (if it exists).

Possible symptoms are slightly rounded face, recent development of small stretch marks despite no weight gain, visual disturbance in my right eye (Central Serous Retinopathy, possibly correlated with Cushing's/elevated cortisol), and just a general stressed out disposition overall. Nothing that screams Cushing's or anything of that matter, but enough to make me curious.

How would I go about getting a diagnosis/testing of cortisol levels? Endocrinologist?

 

[Mew]

No diagnosis.

Until you do bloodwork everything is guesswork and you will worry yourself unnecessarily.

I'm still not clear -- are you ON or have QUIT Finasteride, or are considering TAKING finasteride?

How would I go about getting a diagnosis/testing of cortisol levels? Endocrinologist?

Yea, you'd have to convince your Doctor to take bloodwork related to testing for Cushings, and probably see an Endo for more in-depth evaluation if your bloodwork turns up issues.

Also, 24hr-urine cortisol testing is probably the best way to check cortisol output, vs serum (blood).

 

[Thickandthin]

I've been on finasteride since November. Taking .5mg/day. Any possible Cortisol issues would have been present since before I started taking it though.

Could I just make an appointment with an endo and get the urine test done? Or do I have to have a referral from a GP?

 

[Mew]

Any possible Cortisol issues would have been present since before I started taking it though.

Why would you say this, and how can you say that with any certainty without bloodwork to make such conclusions (without a Doctor's opinion)?

Could I just make an appointment with an endo and get the urine test done? Or do I have to have a referral from a GP?

Depends what country you live in and how the medical system works. Depending where you are, you may only be able to get bloodwork done through a Doctor, since they need to write the requisition form which you take to the lab.

Or, maybe you can pay privately to a lab and have the tests done yourself, without requiring a Doctor. You'll need to call and ask.

Same goes for the Doctor vs. endo, either could order the bloodwork, but to see the endo you may need a referral from GP rather than booking directly -- depends on your medical system where you live.

 

[Thickandthin]

I live in the US w/private insurance.

And I'm not conclusively saying anything. I said might, possibly, maybe, etc. Reason for my suspicions are the symptoms I listed above.

I understand Cushing's is quite rare and while I do have a bit of a beer gut, I don't have major central obesity or a "buffalo hump" or anything like that. So it's probably a long shot, but I was worried that IF cortisol issues were already present, then finasteride might make them worse.

You seem to be pretty well educated on this - what do you think the chances are that finasteride does actually increase cortisol levels?

 

[Mew]

what do you think the chances are that finasteride does actually increase cortisol levels?

I don't know, as it would be completely speculative. However, considering the various hormonal issues some guys have been left with, I'd say anything's possible.

If Finasteride does indeed have a structural affinity to corticosteroids and has a slight inhibitory effect on adrenal steroidogenesis (as per cited studies), then exogeneous corticosteroid-induced Cushing's could be a theoretical possibility from finasteride use.

There's also this bit, from the FDA Propecia Approval Commitee Meeting, where the FDA and various scientists were debating with Merck wether to approve Propecia for hairloss back in the late 90s:

http://www.fda.gov/ohrms/dockets/ac/97/ ... 3352t1.rtf
"Also, in this year, there is a report showing that in a patient treated for benign prostatic hyperplasia, there is an occurrence of severe reversible myopathy associated with finasteride use, and this was clinically and histologically resembling glucocorticoid-induced myopathy."


More info on corticosteroid/glucocorticoid-induced Cushing's:
http://www.nlm.nih.gov/medlineplus/ency ... 000389.htm

See right paragraph on drug-induced Cushing's
http://books.google.ca/books?id=OdGjGH2 ... &ct=result


That said, if you are concerned about Finasteride-related issues, you can always stop taking the medication at any time.