Hormone therapy (Androgen deprivation therapy): What are the side effects and ways of managing them?

‘When I went on hormone therapy, nobody told me what the side effects would be, or how to handle them. And there are some nasty side effects. From things like fatigue and depression, through to weight gain, breast enlargement …
and definitely loss of libido.’

The most common treatment for advanced prostate cancer is hormone therapy, also known as androgen deprivation therapy (ADT), to reduce testosterone and slow the cancer’s growth. Testosterone has many functions in the body. When it is reduced, the body may react in a way that affects your quality of life. 

The most common side effects from hormone therapy are listed on the following pages, but you may not experience them all. It is important that you tell your healthcare team about the side effects you’re having as they may be able to offer you ways to manage them (e.g. medications, techniques).

Loss of sex drive and erectile difficulties

Lowering testosterone levels may cause a reduction in sex drive and erectile difficulties. 

Tips: 

  • Work with a health professional (e.g. psychologist, sex therapist) who specialises in sexuality matters. 
  • Explore ways of being intimate with your partner that are not related to sex. 
  • Medications – Some medications in tablet and injectable forms can be prescribed to manage erectile difficulties. Because these medications can have side effects, discuss with your healthcare team if they are suitable for you. 
  • Implants/devices – If you don’t want to use medications, vacuum devices that draw blood into the penis (e.g. vacuum erection device) or the use of penile implants (e.g. flexible rods or inflatable tubes) could be ways of getting an erection. Members of your healthcare team (e.g. urologist, nurse, sex therapist) can provide you with information about these. 

Hot flushes

Changes in your hormone levels can trigger sudden intense hot sensations in your upper body. 

Tips: 

  • Some medications can help with hot flushes. 
  • Some complementary therapies can help with hot flushes (e.g. acupuncture). 
  • Practise deep breathing and relaxation techniques.

Tiredness (fatigue)

Hormone therapy can make you feel tired because of its effect on your whole body. Fatigue can also be caused by the cancer itself and everything you have to do to manage it.

Tips: 

  • Make sure you get plenty of rest by having regular breaks during the day. 
  • Do what you have to do when you have the most energy. 
  • Plan ahead and prioritise activities so you only do those that are necessary. 
  • Ask for help so you don’t feel you have to do everything. 
  • Do some light exercise (e.g. short, easy walks). 

Weight gain

Changing the level of testosterone can cause men to retain fluid and gain weight. 

Tips: 

  • Make some adjustments to your diet, if necessary. Talk to a health professional (e.g. dietitian) for advice and an eating plan. 
  • Exercise regularly (e.g. walking, jogging, stair climbing, weights, dancing, tennis). 

Loss of muscle mass and strength

Hormone therapy can cause a decrease in muscle tissue or lean body mass. This will affect your strength and the way your body looks. 

Tips: 

  • Talk to a health professional (e.g. physiotherapist) about an exercise program that can maintain your muscle mass and strength. 
  • Talk to a health professional (e.g. dietitian) for advice and an eating plan. 

Swelling and tenderness in the breast area (gynaecomastia)

The change in hormone levels can cause some enlargement of the breast area, which can be uncomfortable and tender. 

Tip: 

  • Talk to a health professional (e.g. doctor) for advice.

Thinning of the bones (osteoporosis)

Lowered testosterone could lead to a loss of calcium and decreased bone density. 

Tips: 

  • Exercise regularly (e.g. walking, jogging, stair climbing, weights, dancing, tennis). 
  • Maintain a healthy weight. 
  • Take Vitamin D and calcium supplements. 
  • See a health professional (e.g. doctor) for medications.  

Risk of heart disease

Some research has shown an increased risk of heart disease for men who are treated with hormone therapy. 

Tip: 

  • Talk to your healthcare team (e.g. doctor) for advice. 

Diabetes

Increased risk of developing diabetes or exacerbating existing diabetes. 

Tips: 

  • Talk to your healthcare team (e.g. doctor, dietitian) about ways of managing your diabetes. 
  • Contact the Australian Diabetes Council for more information (www.australiandiabetescouncil.com). 

Changes to your mood

Dealing with all the challenges and losses that come with cancer can affect your mental health. Hormone therapy has also been shown to increase depression and anxiety in some men. 

Tips: 

  • Talk to your healthcare team (e.g. doctor, nurse, psychologist) to discuss management options. 
  • Consider talking to someone you feel comfortable with and trust. 
  • Remember that these changes may be caused by your treatments. 
  • Exercise regularly (e.g. walking, jogging, stair climbing, weights, dancing, tennis).  

Problems with concentration and memory

Changes to the testosterone level can affect memory and concentration. 

Tips: 

  • Talk to your healthcare team about how to manage memory loss or other cognitive problems. 
  • Use a calendar or organiser to help you keep track of important dates. 
  • Write down things you have to remember. 
  • Make sure you have plenty of sleep. 

The impact of these side effects can be different from one man to the next. Some men can deal with the side effects quite well and others can be severely affected. It is not possible to know how the side effects will affect you until you start the treatment. The chance of having a certain side effect depends on the hormone therapy you have been prescribed and how long you have been on it. 

Generally, side effects will only last as long as you are on hormone therapy. When you stop, the side effects will also lessen. This is why some people are given the opportunity to stop taking hormone therapy for a period of time if the treatment is working well. This is so they can have a break from the side effects (please see one of the booklets in this series: Treatment). Some side effects are irreversible because of the type of hormone therapy (for example, orchidectomy – removal of both testicles).