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Testosterone is the primary male hormone, and plays an important role in establishing and maintaining typical male characteristics, such as body hair growth, muscle mass, sexual desire, and erectile function, and contributes to a host of other normal physiologic processes in the body. The primary systemic treatment for prostate cancer, androgen deprivation therapy (ADT), lowers testosterone and causes side effects related to reversing all of the normal functions of testosterone.

Although most men may experience only a few of these symptoms, the list of potential effects of testosterone loss is long: hot flashes, decreased sexual desire, loss of bone density and increased fracture risk (osteoporosis), erectile dysfunction, fatigue, increased risk of diabetes and heart attacks, weight gain, decreased muscle mass, anemia, and memory loss. “Bad” cholesterol levels rise, particularly LDL and total cholesterol, and muscle tends to get replaced by fat, especially around the abdomen.

Current research indicates a weak link between prolonged ADT and increased risk of dementia; in a subsequent study, no increased risk was shown between ADT and Alzheimer’s. While substitute therapies for ADT are an active area of research for the Prostate Cancer Foundation, ADT is currently a part of the standard of care. While it’s important to be aware of the possible side effects, it should not affect your decision to receive life-extending care.

At this time, it is not possible to predict how severely any individual will be affected by lowering testosterone with hormone therapy, but work is being done to find ways to help predict who might be affected by which effects.

Changes in diet and exercise have been shown to relieve many of the side effects of ADT. Before beginning hormone therapy, every man should discuss the effects of testosterone loss with his doctor and nutritionist, so he can alter his lifestyle to accommodate or head of the changes.

Because hormone therapy is used to treat nearly every man with advanced prostate cancer, it is important to think about ways to prevent, reverse, or identify these effects so that men can live their best lives.

One important approach is considering lifestyle measures that can reduce some of these effects. Eating a heart-healthy diet low in red meat and high in vegetables and fiber, and maintaining physical activity through daily weight-bearing exercise can reduce weight gain and maintain bone and muscle mass. Men should also discuss the increased risk of diabetes, heart disease, weight gain, and high cholesterol with their primary care physicians so that they can undergo screening and, if necessary, treatment for these other illnesses throughout the course of treatment for prostate cancer. When making these changes, it is important to talk with a doctor to ensure that you are planning lifestyle modifications that are safe for you. There are also some strategies that can decrease the hot flashes, including medications and acupuncture.

It is important to check bone mineral density around the time of starting hormonal therapy and every 1 or 2 years following, to assess for loss of bone density. There are medications that can be used to reduce the risk of fracture if early signs of bone loss are found.

Side Effects of 2nd-Generation Hormone Therapy

The newer anti-androgen drugs (abiraterone, apalutamide, enzalutamide, and, most recently darolutamide) are used when prostate cancer has become resistant to traditional ADT and, increasingly, earlier in the management of advanced disease. They each have their own side effect profile. You and your doctor will need to consider your disease status and other medical conditions when choosing among these agents. Because abiraterone is given with prednisone, patients and doctors must be aware of possible side effects associated with steroid treatment as well.

The above blog is a section of our Prostate Cancer Patient Guide. To download the full guide click here.