A Side Effect I Never Expected

When I began taking carbidopa-levodopa for Parkinson’s disease, I expected possible side effects such as nausea, dizziness or involuntary movements. I did not expect to encounter a warning about impulse control disorders.

Dopamine-replacement medications increase or imitate dopamine in the brain. That can improve tremors, stiffness and other Parkinson’s symptoms, but dopamine also plays a role in pleasure, motivation and reward. In some patients, the medication may produce strong urges that are difficult to resist.

The best-known examples are compulsive gambling, shopping, eating and sexual activity. Some people become preoccupied with hobbies or repeat the same activity for hours. Although these problems occur more often with dopamine agonists such as ropinirole and pramipexole, current prescribing information for carbidopa-levodopa products also warns about intense urges and compulsive behavior.

And then there is crossdressing.

A medical journal even published a case report titled “Impulsive Cross-Dressing in a Man with Parkinson’s Disease Treated with Ropinirole.” The man developed a frequent compulsion to crossdress while taking that dopamine agonist. That does not establish “intensive crossdressing” as a standard side effect of carbidopa-levodopa, but it demonstrates that medication-related compulsive behavior can sometimes take a very personal and unexpected form.

Before anybody diagnoses every enthusiastic femulator with a dopamine surplus, an important distinction must be made: crossdressing is not, by itself, an impulse control disorder. Enjoying women’s clothing, dressing frequently or wanting to go out en femme does not make the activity pathological.

It becomes a possible medical concern when the urge is new or suddenly much stronger, feels impossible to control, consumes excessive time or money, causes distress, interferes with daily life or damages relationships. In that situation, the issue is not the clothing. The issue is the loss of control.

Since I was an enthusiastic crossdresser long before I swallowed my first carbidopa-levodopa tablet, I cannot blame the medication for putting me in a dress. At most, I might accuse it of encouraging me to look at one more dress online—or perhaps three!

Humor aside, anyone taking Parkinson’s medication should tell a neurologist about a new or sharply intensified compulsive behavior. Family members may notice the change before the person taking the medication does. The dosage or combination of medications may need adjustment, but Parkinson’s drugs should never be reduced or stopped without medical guidance.

Carbidopa-levodopa has helped calm my tremor and made everyday tasks easier. I have no intention of abandoning a medication that is helping me. I will simply pay attention to any changes in my behavior.

And if another new dress arrives at my door, I promise not to blame dopamine automatically.

Probably.

Sources: Parkinson’s Foundation: Impulse Control and Parkinson’s UK: Impulse Control Behaviours

Wearing Boston Proper

Rachel, another lovely Femulate reader