I could link to Androcur, but text is better:
30% depression, mood swings (lability).
Other uses of CPA include the treatment of benign prostatic hyperplasia, priapism, hypersexuality, paraphilias, hot flashes, and hyperandrogenism in women. In addition, with the exception of the United States – where it is not available and spironolactone, a diuretic with antiandrogen properties, is generally employed instead – CPA is widely used as a component of hormone replacement therapy for trans women.[7]
Side effects
The most serious potential side effect of CPA is hepatotoxicity, and patients should be monitored for changes in liver enzymes, especially if taking a high dose (e.g., above 50–100 mg/day, and even more especially at the range of 200–300 mg/day).[8] Toxicity is dose-dependent, and the low doses used in birth control pills (2 mg) do not appear to represent a significant risk.[9]
Suppression of adrenal function and reduced response to adrenocorticotropic hormone (ACTH) have been reported.[citation needed] Low cortisol levels may impair carbohydrate metabolism, and patients with diabetes mellitus taking insulin may require adjustments in their dosage.[citation needed] Low aldosterone levels may lead to hyponatremia (sodium loss) and hyperkalemia (excess potassium).[citation needed] Patients taking CPA should have their cortisol levels and electrolytes monitored, and if hyperkalemia develops, should reduce the consumption of foods with high potassium content or discontinue the medication.[citation needed]
Used alone, CPA does not appear to have a significant effect on blood clotting factors, but in combination with ethinyl estradiol, as in combined oral contraceptive pills, presents an increased risk of deep vein thrombosis.[10] Women who take contraceptive pills containing CPA have a six- to seven-fold increased risk of developing thromboembolism compared to women not taking a contraceptive pill, and twice the risk of women who take a contraceptive pill containing levonorgestrel.[11]
CPA is also associated with the formation of stretch marks, due potentially to glucocorticoid activity[contradiction] and/or causing dry skin.[12]
Similarly to other antiandrogens and antigonadotropins, CPA has been associated with the incidence of depression, which can reportedly occur in up to 30% of patients.[13] However, paradoxically, antidepressant effects have also been reported.[14] This may be due to the antiglucocorticoid properties of CPA, as similar antidepressant effects have been observed with other antiglucocorticoids, such as metyrapone and mifepristone.[15][16]
Due to suppression of the production of estrogens, long-term use of CPA without concomitant estrogen therapy may result in the development of osteoporosis.[17]
Side effects in males resulting directly from the antiandrogen properties of CPA include physical demasculinization, physical feminization (including gynecomastia (breast enlargement)), breast pain/tenderness, galactorrhea (milk outflow), sexual dysfunction (including loss of libido and erectile dysfunction), impaired spermatogenesis, and reversible infertility.[4]
Withdrawal effects
Abrupt withdrawal of CPA can be harmful, and the package insert from Schering AG recommends that the daily dose be reduced by no more than 50 mg at intervals of several weeks.[citation needed] The primary concern is the manner in which CPA affects the adrenal glands. Due to its glucocorticoid activity,[contradiction] high levels of CPA may reduce ACTH, resulting in adrenal insufficiency if discontinued abruptly.[citation needed] In addition, although CPA reduces androgen production in the gonads, it can increase the production of adrenal androgens, in some cases resulting in an overall rise in testosterone levels.[18] Thus, the sudden withdrawal of CPA could result in undesirable androgenic effects. This is a particular concern because androgens, especially DHT, suppress adrenal function, further reducing corticosteroid production.[19] In theory, 5α-reductase inhibitors such as finasteride and dutasteride could, to some extent, mitigate this effect by preventing the conversion of testosterone into its more potent relative DHT.[citation needed]
A paradoxical effect occurs with certain prostate cancer cells which have genetic mutations in their androgen receptors. These altered androgen receptors can be activated, rather than inhibited, by CPA. In such cases, withdrawal of CPA may result in a reduction in cancer growth, rather than the reverse.[20][/q]
