19 September 2022

Written by Bernie Riley, PCFA General Manager of Supportive Care Programs

What is hormone therapy?

Hormone therapy, otherwise known as Androgen Deprivation Therapy (ADT), is a group of medicines used to reduce the male sex hormone (androgens) testosterone and commonly used to treat prostate cancer.

Testosterone is important for the development of male sexual organs, including the prostate, and libido (or sex drive) and other masculine features like an increased muscle and bone mass and body hair. Most of this testosterone is produced in the testes and a smaller proportion in the adrenal glands which sit above the kidneys.

In men with prostate cancer, testosterone also causes prostate cancer cells to grow and spread, and so depriving prostate cancer cells of testosterone is important to slow growth and reducing risk of cancer spreading and reduce some symptoms caused by the cancer. Hormone therapy may also over a number of weeks reduce your PSA levels and offer long term control of the cancer by limiting the amount of testosterone available to prostate cancer cells wherever they are in the body.

People seeking any further information could call PCFA’s Telenursing Service on 1800 22 00 99 to chat with the team about their options. We’re here to help!

There are different types of hormone therapy:

  1. Luteinizing hormone-releasing hormone agonists (LHRH agonists) LHRH agonists trick the body into stopping production of its own LHRH, causing the testicles to stop producing testosterone. Examples of LHRH agonist medications include Eligard®, Lucrin®, Zoladex® and Diphereline®.
  2. LHRH antagonists reduce testosterone production by blocking the messages from the pituitary gland to the testicles. The drug Firmagon® or Degarelix is a LHRH antagonist
  3. Anti-androgens -Anti-androgen medicines are a type of hormone therapy that works by blocking the action of testosterone on the prostate cancer cells. For example: Bicalutamide (Cosudex®) , Cyproterone acetate (Androcur®) or Nilutamide (Anandron®).
  4. Novel Hormonal agents- also work to reduce the ability of prostate cancer cells to grow and spread through several different mechanism. Eg Abiraterone acetate (Zytiga ®), Darolutamide (NUBEQA®) or Apalutamide (Eryland®) and Enzalutamide (Xtandi ®).

Many men with prostate cancer may be on one or a combination of hormone therapy, delivered in oral and/or injection form.

It’s important that you speak with your urologist or treating doctor about what options you are eligible for.

What are the side effects? 

Men on hormone therapy may experience a wide range of side effects. Sometimes these can be minor or for other men, they may be more frequent and distressing.

Common possible side effects are:

  • Loss of libido or sex drive.
  • Erection problems.
  • Hot flushes and night sweats.
  • Fatigue (tiredness).
  • Weight gain from increased body fat.
  • Declining bone density (osteoporosis).
  • Loss of muscle mass and muscle weakness.
  • Depression or mood swings.
  • Poor memory, concentration and physical unsteadiness.
  • Breast swelling and breast tenderness and genital shrinkage
  • Increased risk of cardiovascular disease and diabetes.

After stopping hormone therapy, some side effects may diminish with time, but sometimes the side effects never go away.

Recovery from hormone therapy side effects after stopping treatment will depend on your age, the type of hormone therapy you were on, whether you were on a short course of hormone therapy over a few months or a longer course over several years, and whether the hormone therapy was continuous or intermittent.

How can I manage side effects I’m experiencing?

The good news is, there is support available and ways that you can reduce the impact of many side effects. PCFA’s Telenursing team is here to support you through it. We’ve provided some tips for the most common side effects, and some ideas for improve general physical health and wellbeing.

If you need support, please reach out to PCFA’s Telenurses on 1800 22 00 99. We can also provide a referral to PCFA’s Counselling Service.

Loss of libido and sex drive

For some men, hormone can result in tiredness, reduced energy and changes in your physical appearance such as weight gain, and/or shrinkage of your testicles. All of these things can result in reduction or loss of sexual desire. As a result, some men experience lower confidence and self-esteem, which can also impact relationships. To help navigate any changes to your sex drive, it’s important to talk about it. Don’t go through it alone. You can chat with your healthcare team, or with a psychologist or sex therapist/counsellor (including PCFA’s Counselling Team).

Erectile dysfunction

Many men on hormone therapy will experience low testosterone levels which is suggested to contribute to poorer quality and less frequent and durable erections. Men also commonly experience penile shortening or shrinking as a side-effect of hormone therapy. PCFA’s Telenursing and counselling Service can help explain your options. You can also read more about common treatment options here.

Hot flushes and night sweats

There are a couple of things you can do to help reduce the impact of hot flushes and night sweats. These include – drinking at least 6 to 8 glasses of water per day and reducing alcohol intake and drinks that contain caffeine such as tea, coffee and cola. Also reduce the amount of spicy food you eat. In addition, keep your room at a cool temperature where possible. Use light cotton bed linen and wear cotton clothes, including underwear. At night it can also help to lay a towel on your sheet as this can be easily changed during the night. 

Depression or mood swings
It’s normal to experience a change in emotions while on hormone therapy. Don’t block your emotions and reactions – this can create greater stress, anxiety and frustration. Whether they are related to the physical changes, loss of libido, a change in your relationship or your ability to do the things your used to do, talking these over with someone close may help you cope and better manage your situation. Some people find it more comfortable to talk things over with a support group, a helpline or one of PCFA’s counsellors. Also take time out to the things you enjoy and try to continue to be involved in social activities and hobbies you enjoy.

Declining bone density (osteoporosis)

Testosterone helps keep your bones strong, which means hormone therapy can cause your bones to lose calcium and become more brittle. This can begin within the first 12 months of starting treatment. Talk to your specialist and a PCFA Specialist Nurse about how you can prevent bone loss and weakening or call us on 1800 22 00 99 to ask about how you can monitor for early signs that bone loss may be impacting you.   

Other side effects

In addition to the above side effects, fatigue, and other side effects like loss of muscle mass, poor memory or other side effects – getting active and eating well can help make a difference.

Physical activity is vital for maintaining and improving your physical and psychological health. It is important to do some physical activity most days, if not every day.  A targeted exercise plan designed by an accredited exercise physiologist can help slow the progression of your prostate cancer and reduce the impact of all side effects of treatments and prevent or delay the development of complications.

The most effective forms of exercise are:

  • cardiorespiratory exercise such as fast walking, jogging, cycling and swimming
  • resistance training exercises such as lifting weights, stair climbing and high intensity resistance workouts.

You can find more information at www.essa.org.au/find-aep. You may also be eligible for a subsidy to help fund 5 visits to an allied health professional such as an exercise physiologist, ask your GP to create a Chronic disease management plan to include these visits.

Other tips for improving your wellbeing include:

  • Stop smoking, if you need help talk to your treating team or alternatively contact Quitline on 13 78 48.
  • Reduce your alcohol intake and salt intake. Eat a healthy, balanced diet containing plenty of fruit and vegetables, wholegrain foods and lean meat, fish, poultry and low-fat dairy, avoid alcohol, animal fats, processed meals, biscuits, cakes and pies, salt and added sugars and drink plenty of water. 

PCFA’ s booklets on Understanding Hormone Therapy and Understanding Health and Wellbeing have greater detail and extra tips on how manage hormone therapy and its effects. PCFA Support services can also further expand and link you with the information and help you may need to tackle the challenges of hormone therapy.