Reducing Side Effects of Hormone Therapy for Prostate Cancer | Prostate Cancer Staging Guide

PCRI’s Executive Director, Mark Scholz, MD, discusses common side effects that men experience while undergoing hormone blockade and their treatments.

1:50 The most important side effects to be aware of while on hormone therapy (TIP) are the loss of muscle mass and fatigue. Without testosterone, some men will experience the loss of around 30-40% of their muscle mass and thus will experience intense fatigue. These side effects are manageable through weight training 2-3 times per week, and some men may even gain muscle mass while on hormone blockade if they are consistent with their weight training.

3:28 While taking TIP men will experience a drop in their metabolic rate and if a man keeps the same diet as before the TIP then he will most likely gain weight. Therefore, men should consider lowering their caloric intake in anticipation of and during hormone blockade.

3:58 The loss of interest in sexual activity is a notable but temporary side effect while on TIP. Men might be able to perform as they normally would with the use of medications like Viagra and Cialis; however, men will experience a loss of the desire to have sex for the duration of the hormone blockade and a short time afterward.

4:46 Breast enlargement occurs in around 33%-50% of men on hormone blockade depending on the specific medicine. Once enlargement occurs, it is only treatable with plastic surgery. However, there are preventative measures a man can take to prevent breast enlargement before it happens. One is to take an estrogen-blocking pill called Femara. There are no side effects for men. Another is to have radiation treatments to the nipple area prior to hormone blockade. Men who are uncompromising about breast growth may consider both preventative options.

6:04 While not dangerous hot flashes are an uncomfortable and intrusive symptom of TIP. Luckily, it can be treated effectively. Perhaps the most effective treatment is a small dose of estrogen delivered by a patch. Other less effective treatment options are the use of Effexor (an antidepressant) or Neurontin (typically used for peripheral neuropathy for seizures).

7:06 Men taking TIP may begin to experience a greater range of emotions than before treatment. While some welcome this change, others may find it intense and uncomfortable. For those men a medication like Effexor is effective for stabilizing their mood.

7:48 The side effects of TIP may show up as laboratory abnormalities that are important to be aware of especially when talking with a doctor who is unaware of the side effects of TIP. For example, men on testosterone blockade will see a usually inconsequential drop in their red blood cell count (but may result in fatigue in extreme cases) that may appear as something more serious to your doctor.

8:35 There are some TIP (esp. Zytiga, Casodex) that cause liver irritation in certain men. Thus, it is important to have blood work done periodically (especially at the beginning of treatment) to ensure that there is no irritation of the liver. If there is, then that medicine must be stopped immediately.

9:01 High blood pressure has been observed as a side effect in 10-20% of men who are using second-generation TIP (e.g. Zytiga, Xtandi). It can usually be treated with typical blood pressure medicines. If the high blood pressure is too severe, however, then treatment with that medication may need to be stopped.

9:31 Osteoporosis, or loss of calcium in their bones, is another possible side effect for men on hormone blockade.

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