Hormone therapy related effects
- Side effects
- Hormone therapy related effects
- Anatomy
- Structure
- Function
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Hormone therapy related effects
Hormone therapy related effects
No matter what prostate cancer treatment you undergo, there is always the possibility of developing side effects. However, not everyone gets side effects; if you do get side effects, not everyone feels them in the same way. Side effects of hormone therapy are dependent on the following:
- The type of hormone therapy (surgery or drugs)
- Your medication dose and duration (how long you take it for)
- Your overall health
- The side effects, although transient, can be difficult to manage, and some patients are tempted to stop treatment. However, it is important to bear in mind the major therapeutic impact of hormone therapy. In addition, there are usually ways to manage them and help the patient overcome them. Here is a guide to inform you about this treatment and provide you with some helpful tips for managing your symptoms and taking care of yourself.
- Do not hesitate to talk about all of your side effects with your doctor during your follow-up visits.
Decrease in libido
The decrease in hormone production will result in the loss of sexual desire (libido), whether you have undergone surgical or medical castration. After more than two years of continuous medication, testosterone levels may never return to normal. Medications that facilitate erection are not of much help when there is no libido.
Nevertheless, despite the absence of sexual desire, patients may still resort to medical means that allow for an erection (see below). However, in most cases, your sexual desire gradually reappears once the treatment is completed.
What you can do
- Discuss it with your doctor. You may need to consult a sexologist, either alone or with your partner. These professionals can help couples strengthen their bonds, communicate, and explore different ways of being intimate. For more information, we invite you to watch our conference on sexuality by clicking here.
Erectile dysfunction (inability to achieve an erection)
- This is a very common side effect of hormone therapy due to the loss of libido. It can be permanent with the removal of both testicles. Otherwise, it persists throughout hormonal treatment. It may take 3 to 12 months after hormone therapy to regain erectile capacity. If erectile capacity does not return on its own, treatments may be necessary.
- Your erectile capacity after hormone therapy depends on your sexual function before treatment, your age, and your overall health.
What you can do
- Your doctor will prescribe treatment to help you regain your erectile capacity and achieve a satisfying sex life after your treatment.
- Treatments include oral medications such as tadalafil, sildenafil, vardenafil; the MUSE pill, penile injection, vacuum pump, or penile implant through surgery.
For more information on erectile dysfunction, see our section on side effects.
Hot flashes
Although this discomfort is typically associated with women, hot flashes can occur in about 50 to 80% of men undergoing hormone therapy. It is a sudden sensation of heat in the face and chest that then spreads to the rest of the body in waves, lasting 2 to 30 minutes. You may also sweat, flush, feel your heart pounding, or feel anxious. The exact cause of hot flashes is unknown, but it may be related to how hormones interact with the hypothalamus, part of your brain that controls body temperature.
Hot flashes generally disappear when your body adjusts to the treatment or when the treatment is stopped, but there are several measures you can take on a daily basis to better manage them.
What you can do
- Drink fluids to stay hydrated, preferably cool non-alcoholic and caffeine-free beverages;
- Avoid spicy foods;
- Wear breathable clothing (e.g., 100% cotton clothing);
- Layer clothing so you can remove layers when you feel too hot; Keep good airflow in the house by opening windows and using fans;
- Take a shower or bath with lukewarm water rather than hot;
- Place sponge towels on your mattress and pillows if you tend to sweat excessively in bed;
- Practice slow, deep breathing when you feel the onset of a hot flash, or try relaxing activities like yoga or meditation.
- Discuss your hot flashes with your doctor if they are unbearable, as there are treatments that can help you.
Weight gain and muscle loss
Weight gain and muscle loss are common side effects of hormone therapy. Increased adipose tissue causes weight gain, and muscle tissue loss leads to decreased strength.
What you can do
- You can mitigate your weight gain and muscle loss through a healthy diet and physical activity.
- You can also seek the help of a nutritionist and kinesiologist (physical activity specialist) for additional support. Discuss this with your doctor, nurse, or CLSC social worker.
Fatigue
Fatigue makes a person more tired than usual and can interfere with daily activities and sleep. Fatigue may diminish over time. It is also possible that it will persist well after hormone therapy is completed.
What you can do
- Physical activity can help cope with fatigue. For more information on managing fatigue, see our section on side effects.
Concentration difficulties, irritability, or impatience
You may feel more emotional, expressive, angry, or irritable. You may also be more distracted and forgetful.
What you can do
- Keep a journal to help identify disruptive events and triggers;
- Start a conversation with a trusted person to help you put things into perspective;
- Discover activities and hobbies that make you feel good (e.g., music, reading, pet, outdoor activity, etc.);
- Develop strategies to cope with stress (e.g., breathe slowly, recognize your limits, take a moment to pause).
Swelling or tenderness of the breasts
Breast swelling in men is called gynecomastia. It is a common side effect of prostate cancer hormone therapy, especially when an oral anti-androgen such as bicalutamide is administered.
What you can do
- Discuss this side effect with your doctor.
Loss of bone density (osteoporosis)
Osteoporosis is a late side effect that may occur with certain hormonal medications (LH-RH). Bone mineral content assessment can determine the risk level.
What you can do
- Osteoporosis can be slowed or prevented through physical exercise and a healthy diet.
- Your doctor may prescribe products or medications to prevent or treat this complication: calcium, vitamin D, and even medications like bisphosphonates (if bones are very fragile due to age or the effects of hormone therapy).
Changes in masculine characteristics
- Hormone therapy causes hair loss and a decrease in testicle size. Men taking LH-RH analogs notice that their scrotum loses volume over time.
Depression
Hormone therapy for prostate cancer sometimes causes depression and changes in emotional stability.
What you can do
- Depression can be treated with antidepressants. To learn more about depression and how to recognize signs, see our section on side effects.
Anemia
Hormone therapy causes anemia in some men. When the number of red blood cells or the concentration of hemoglobin is low, the body tissues do not get enough oxygen. This results in fatigue and shortness of breath.
What you can do
- Iron supplementation is provided through tablets or directly intravenously, depending on tolerance and circumstances.
- Iron levels can only be improved through diet when iron deficiency is a result of an unreasonable diet.
Increased risk of cardiovascular diseases
This is because hormone therapy leads to weight gain, reduced exercise capacity, and increased blood levels of lipids and glucose. It is important to monitor your risk of heart disease and try to prevent or correct these diseases as much as possible. In fact, there are now two information sheets, one for you as a patient and one to give to your family doctor.
You should download and print them. If you don’t have a printer, contact us at 1 855 899-2873. We will send them to you by mail. The sheets are important because they highlight your role as well as that of your family doctor in reducing your risk of heart attack or stroke.
Information sheet for you (blue) and for your family doctor (purple)
Increased risk of developing metabolic syndrome
Hormone therapy decreases your cells’ sensitivity to insulin. It also causes an increase in your adipose tissue and a decrease in your muscle mass. These effects increase the risk of diabetes, dyslipidemia (e.g., high cholesterol levels), obesity, hypertension, etc. in men receiving hormone therapy.
What you can do
- Monitor your weight gain, diet, and get moving!
Tumoral flare reaction
The administration of LH-RH analogues initially causes a temporary increase in testosterone levels lasting about a week. This increase can temporarily worsen your symptoms; this is called a tumoral flare reaction. During this reaction, you may experience more urinary problems or bone pain.
Your doctor will prescribe an anti-androgen such as Casodex. Administered orally in pill form, anti-androgens block the action of androgens (male sex hormones) for a period of time to reduce flare symptoms.
Side effects related to orchidectomy
Surgical castration causes very few complications. Typically, postoperative pain, swelling of the scrotum, and bleeding from the wound are minimal. As with any surgical procedure, there may be an infection at the incision site. This infection will then be treated with antibiotics.
This surgery results in permanent side effects, including erectile dysfunction and decreased libido due to low testosterone levels.
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Sources and references
Last medical and editorial review: April 2024. See our web page validation committee and our collaborators by clicking here.
On this page:
Discover our animated video!
Symptoms, risk and screening
Are you over 50 years old, or have you been having urinary problems for some time now? This video is for you! Several diseases can affect your prostate, and it’s important to detect them early. Let’s take a closer look.
Anatomy
What is the prostate
The prostate is a gland:
- Located between the bladder and the penis, just in front of the rectum;
- Formed of 2 lobes which surround the urethra, a canal that runs through the center of the prostate, from the bladder to the penis, letting urine and sperm flow out of the body;
- The size of a walnut, which grows larger in size in your forties;
- That has a soft, spongy texture to the touch like a small, ripe plum.
The prostate is made of:
- Gland cells that secrete liquids for ejaculation;
- Muscle cells that participate in the evacuation of your sperm during ejaculation;
- Fiber cells that maintain the structure of the gland.
Around the prostate, we find:
- The seminal vesicles, glands that produce sperm and that are located on either side of the prostate;
- The vas deferens, the tube that carries sperm from the testicle to the seminal vesicles;
- The nerve bundles that control your bladder and erectile function and that are located on either side of your prostate.
Structure
Three main zones of the prostate
Peripheral zone
- The peripheral zone is the largest area of the prostate. It can easily be felt by the doctor during a digital rectal exam (DRE).
- Most prostate cancers start in the peripheral zone.
Transition zone
- This is the area located in the middle of the prostate, between the peripheral and central areas. It surrounds your urethra that runs through the prostate.
- With age, the transitional area increases in size until it becomes the largest portion of your prostate. This is called benign prostatic hyperplasia (BPH) or enlarged prostate.
Central zone
- It is the part of the prostate that is farthest from the rectum. This is why prostate tumors located in this area can not be felt by the doctor during a digital rectal examination.
- If the doctor is in doubt, the following information will help decide if additional investigation is necessary:
- Your PSA level
- Your age and family history
- Your ethnic origin
Fonction
In short
Your fertility and natural fertilization
- It produces … a prostatic fluid rich in enzymes, proteins and minerals that nourishes and protects your spermatozoa.
- It makes … a protein (APS) that is used to liquefy your sperm to facilitate the mobility of your spermatozoa.
- It allows … ejaculation by contracting.
- It promotes … fertility through its enzymes facilitating the penetration of sperm through the cervix.
- It is not related to the mechanism of erection. Therefore, the origin of erectile dysfunction lies elsewhere.
Additional details
Exocrine Function
The prostate is made up of thousands of tiny fluid-producing glands. Specifically, the prostate is an exocrine gland. Exocrine glands are so-called because they secrete through ducts to the outside of the body (or into a cavity that communicates with the outside). Sweat glands are another example of an exocrine gland.
The fluid that the prostate gland produces forms part of semen, the fluid that carries sperm during orgasm. This fluid, produced in the prostate, is stored with sperm in the seminal vesicles. When the male climaxes, muscular contractions cause the prostate to secrete this fluid into the urethra, where it is expelled from the body through the penis.
Urine Flow
The prostate wraps itself around the urethra as it passes from the bladder to the penis. Prostatic changes can affect urine flow. Increasing the size of the prostate or muscle tone may impede the flow of urine due to the close anatomical relationship between the urethra and the prostate.
Prostate Specific Antigen (PSA)
The prostate also produces a protein called prostate-specific antigen (PSA). PSA is released with the ejaculatory fluid and can also be traced in the bloodstream. The testing of PSA levels in the blood is used to detect prostate cancer. The level of PSA in the blood is usually measured in nanograms of PSA per milliliter of blood (ng/mL).
A raised PSA level
Usually, a PSA rate of less than 4 nanograms per milliliter of blood is normal, but age should also be taken into consideration as PSA levels gradually increase with age. A rise in PSA concentration may indicate the presence of:
- An enlarged prostate (benign prostatic hyperplasia)
- An inflammation or infection of the prostate (prostatitis)
- A prostate cancer
Your doctor will have you undergo other tests to determine the exact cause of the increase in your PSA.
We are here for you
You have questions or concerns? Don’t hesitate. Contact us at 1-855-899-2873 to discuss with one of our nurses specialized in uro-oncology. They are there to listen, support and answer your questions, and those of your family or your loved ones. It’s simple and free, like all of our other services.
Also take the time to visit each of our pages on this website, as well as our YouTube channel, in order to get familiar with the disease, our expert lectures, our section on available resources, the support that is offered to you, our events and ways to get involved to advance the cause..
Staying Informed
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The medical content and editorial team at PROCURE
Our team is composed of urologists, and nurses certified in uro-oncology with a deep knowledge of prostate cancer and other diseases related to the genitourinary system. Meet our staff by clicking here.
Sources and references
- Prostate Cancer – Understand the disease and its treatments; Fred Saad, MD, FRCSC and Michael McCormack, MD, FRCSC, 4th et 5th editions
- Canadian Cancer Society
- Prostate Cancer Foundation-PCF.org
- National Cancer Institute-USA
- American Cancer Society
- Memorial Sloan Kettering Cancer Center
- Prostate Cancer UK
Last medical and editorial review: September 2023
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