In early 2011 I had a rare adrenal tumor removed called a pheochromocytoma. Doctors also removed the affected adrenal gland the tumor was attached to. This type of tumor spontaneously, without provocation, releases epinephrine, norepinephrine and dopamine. Chemicals collectively referred to as catecholamines. These are your fight or flight chemicals and when the tumor releases them you feel very “wound up”. After the tumor was removed, my catecholamine levels went back to normal and I again felt normal.

In late 2011 I started Propecia. I started on .5 milligrams per day and later reduced that dose to .5 milligrams 3x per week, which I am currently taking. A dose much lower than the standard dose of 1 milligram per day. Almost immediately after starting Propecia, I began to feel like I did when I had the tumor. Spontaneously “wound up” even in the absence of external stimulus.

Recent testing reveals my catecholamine blood levels are back up and my oncologist suspects another tumor. Appropriate scans for tumor detection are occurring “as we speak”.

Are you aware of any evidence that Propecia can cause elevated levels of epinephrine, norepinephrine or dopamine? I have read numerous claims that Propecia can cause anxiety. If this is true, could this anxiety then trigger a “chemical cascade” in which catecholamines are released at high levels.

Thank you for your expertise in this matter.

I know I must sound like a broken record, but you really need to discuss personal medical issues with your doctor.

I wouldn’t expect Propecia to have anything to do with dopamine or other catecholamines. Propecia is a 5 alpha reductase inhibitor, which works to diminish the conversion of testosterone to dihydrotestosterone (DHT).

In my experience, the anxiety caused by Propecia are in those men who read too much about Propecia’s side effects on the Internet without discussing the issues with their doctor. Then again, anxiety could indeed be a rare symptom associated with Propecia, but it’s something that needs further study. The studies that I’ve seen which link Propecia to anxiety or depression were based on interviews with men from a Propecia complaint forum, and the bias is something I’ve discussed before.

DR. R
did this patient you mentioned last week take propecia by any chance as well? I just want to know as to if he lost non transplant hair after the transplant through the years was it with or without propecia

So everyone is up to speed, the post from last month you’re referring to is here — Great Hairline, Thin Top and Crown, Low on Donor Hair

This patient did not take Propecia (finasteride) over the period of time we worked with him. Many people who are satisfied with their transplant results don’t “officially” recognize that they have a progressive process and in men like this, practicing denial as it goes on is common. In older men (like this man, over 40 years old), their decision to not take Propecia is common, as these men feel as if they beat the balding process and will not bald more over time. And in men over 40, this is not an unreasonable conclusion as the balding process often slows or stops on its own — but clearly this man lost his gamble as his balding pattern acted as if he was in his 20s, not 40s.

When I see a man under 35 years old losing hair, I stress the need for Propecia to guarantee, as much as possible, that the balding process has slowed or stopped. It is often a battle between us, as no one really wants to take the drug, especially with good transplant results. I can not stress the importance of staying on the drug to stop the type of changes that this man had and although there is no real guarantee, it is reasonable to take the drug for life.