Hormone Therapy for Prostate Cancer: The Side Effects No One Warned Me About

About three weeks after my first injection, it happened at night. I went from comfortable in the air conditioning to feeling like I had walked into a blast furnace. I broke out in a sweat and threw the covers off. I was born in Florida, I have lived in Florida my whole life, and I know heat. Hot flashes are different. After 35 years as a surgeon and a man who thought he understood his own body, hormone therapy taught me otherwise. This is the article I wish someone had handed me before my first shot.

Hormone therapy, properly called androgen deprivation therapy or ADT, is one of the three frontline treatments for prostate cancer. It works, and for many men it is essential. But the side effects are real, they are under-discussed, and knowing them in advance changes how you experience them. Education does not make the side effects disappear. It makes them survivable.

What ADT Actually Does

Prostate cancer feeds on testosterone. We have known this since 1941, when researchers discovered that lowering testosterone caused prostate tumors to shrink. ADT cuts off that fuel supply, driving testosterone down toward zero.

It is most often given as an injection, sometimes called a depot or "depo" shot, placed under the skin every one, three, or six months. Common agents include Lupron and similar medications like Eligard. Newer oral and injectable formulations are arriving as well.

ADT does not cure prostate cancer. It controls it, often dramatically, by starving the tumor of the hormone it needs to grow.

One quirk worth knowing: standard ADT briefly raises testosterone before it drops it. If there is cancer in the bones, that flare can cause a short increase in pain. The drop comes, but it can lag a week or two behind.

The Side Effects to Expect

I had nearly all of them. Here is the honest list, so nothing catches you off guard:

• Hot flashes - similar to menopause, often starting within weeks. Some men get 20 to 30 a day, disrupting work and sleep.
• Fatigue - for me it arrived at the end of the day and was unlike ordinary tiredness. It can be profound.
• Loss of muscle and strength - testosterone builds muscle, so removing it threatens it, especially over longer courses.
• Loss of libido and erectile dysfunction - interest in sex can drop to essentially zero, which many men find one of the hardest changes.
• Mood swings - not universal, but possible. Be ready for it.
• Weight gain and gynecomastia - breast tissue growth becomes more likely with longer therapy and may not reverse.
• Loss of bone density - a concern mostly with longer treatment, occasionally leading to fractures.
• Insulin resistance - ADT can worsen or trigger Type 2 diabetes.
• Lipid and liver changes - usually visible only on blood tests, but worth monitoring.

Not every man gets every effect, and severity varies enormously. Some men barely notice. Others genuinely cannot tolerate the therapy. Both are normal.

What Actually Helped Me

This is the part that matters most, because much of what follows is within your control. Here is what I did, and what I encourage every man to discuss with his own physicians:

Resistance training, without exception. Lifting weights two to three times a week is the single most effective defense against ADT-driven muscle loss. I did not lose muscle or strength over my treatment, and I credit weights for that. Find a trainer long enough to learn proper form, then keep going.

Walking with purpose. I walked two to four miles, two to four times a week. It preserves muscle, lifts mood through endorphins, and supports overall recovery.

A practical fix for hot flashes. A nursing colleague in menopause recommended a cooling device that blows cold air through a sheet. For a one-time cost, it solved my worst nights, and I still use it. I skipped the prescription option after weighing its cost and side effects.

Managing weight and metabolism early. With my doctor, I addressed weight and blood sugar proactively so ADT would not worsen my diabetes.

Intermittent ADT: A Conversation Worth Having

The standard course is often two years. But prolonged ADT can lead the cancer to become "castration resistant," meaning it stops responding to hormone suppression. That risk is part of why some oncologists now use intermittent ADT, shorter courses followed by watchful waiting, with the goal of pushing resistance further down the road.

When my cancer recurred in four small pelvic lymph nodes, four of five specialists recommended two years of ADT plus full pelvic radiation. One radiation oncologist offered an alternative: six months of ADT, then watchful waiting. After research and reflection, I chose the shorter path. I received two injections twelve weeks apart, my PSA returned to undetectable, and radiation came off the table. My PSA has stayed undetectable since.

I am not telling you to make my choice. I am telling you that more than one reasonable path usually exists, and you deserve to understand all of them.

The Bigger Lesson

The side effects of ADT taught me something I had missed in 35 years of practice: the patient's experience of treatment is its own kind of medicine. The fatigue, the hot flashes, the loss of libido, these are not footnotes. They shape your daily life. But nearly every one of them can be blunted by the things you do for yourself: lifting, walking, sleeping well, eating to lower inflammation.

Knowledge did not spare me the heat of that first night. It gave me a plan for the morning after.

References

• Huggins C, Hodges CV. Studies on prostatic cancer: The effect of castration on advanced carcinoma of the prostate gland. Cancer Res. 1941;1:293-297.
• Nguyen PL, et al. Adverse effects of androgen deprivation therapy and strategies to mitigate them. Eur Urol. 2015;67(5):825-836.
• Crook JM, et al. Intermittent androgen suppression for rising PSA after radiotherapy. N Engl J Med. 2012;367(10):895-903.
• Galvão DA, et al. Combined resistance and aerobic exercise program in men on androgen suppression. J Clin Oncol. 2010;28(2):340-347.
• Saylor PJ, Smith MR. Metabolic complications of androgen deprivation therapy. J Urol. 2013;189(1 Suppl):S34-S42.