23 May 2023

By Tim Baker

Among the many potential side effects of hormone therapy, (or Androgen Deprivation Therapy), one that gets perhaps too little attention is the risk of cognitive decline. Numerous studies have indicated an increasing risk of cognitive impairment from long term ADT.

While many men struggle with the loss of libido and sexual function, muscle mass and bone density, increased risk of cardio-vascular disease and diabetes and depression, it’s easy to overlook the slow creep of impaired cognition. Like the proverbial frog immersed in gradually heated water, by the time you register the danger it might be too late.

This is an especially critical issue given that survival times even for advanced prostate cancer continue to RISE, because obviously we don’t want to just live, but to live well. The good news is, there is much you can do to maintain cognitive function and, happily enough, many of these strategies address the other side effects of ADT.

In my own case, I’d barely registered the risk of cognitive decline amid the numerous other impacts of prostate cancer and its treatments until it became unignorable. I’d been invited to the Ubud Writers Festival in 2017, nearly two years after my diagnosis, a welcome ray of light in an otherwise bleak time.

My delight at being back in the Island of the Gods and its spiritual heart in Ubud was only marred by the confronting realisation that I had trouble working out where I needed to be and when. Given a schedule of my four festival appearances over a week, I found I could barely keep track of the various times, dates and venues and at one point was reduced to tears staring uncomprehendingly at the spreadsheet I’d been emailed by festival organisers, as if it was in a foreign language.

The prospect of ongoing cognitive decline is bad news for anyone but was especially sub-optimal as someone who writes for a living. Fortunately, that decline seems to have slowed or stopped completely, thanks to a variety of management strategies:

  1. Exercise. The best way to mitigate a range of side effects from ADT is physical activity. Exercise promotes blood flow to the brain, can enhance neuroplasticity and improve cognitive function.

  2. Mental exercise. Happily writing for a living helps maintain cognitive function, a case of use it or lose it. I’ve also taken up playing Wordle daily. Other word or numerical games, like Scrabble or Sudoku, learning new skills, a foreign language or a musical instrument, can help arrest cognitive decline.

  3. Diet. A heathy plant-rich diet based on fresh fruit and vegetables, fish and other seafood, whole grains, lean proteins and healthy fats (avocado, olive oil), nuts and berries can also promote brain health. Reducing alcohol consumption is also recommended.

  4. Social interaction: Remaining socially engaged, having regular contact with family and friends, joining clubs or other social groups or support groups, helps promote mental well-being and avoid a sense of social isolation.

  5. Reducing stress. Mindfulness practices like meditation, breathing exercises and other stress management techniques help minimise the deleterious effects of stress on mental well-being.

  6. Good quality sleep. In slumber we rest, regenerate and refresh. If you’re not getting enough sleep, your brain and body does not get an adequate time to repair. Practice good sleep hygiene: no electronic devices half an hour before bed, a regular pre-sleep routine and preserve your bed as a sanctuary purely for sleep. If sleep problems persist see a qualified sleep therapist.

Eight years on, I continue to make a living as a writer, meditate and exercise daily, eat and sleep well and seem to be managing my cognitive health effectively. One thing I wish I’d done at the start was establish a baseline for cognitive function with any one of a range of assessment tools for cognition. Speak to your GP to see if he can arrange such a baseline test for you.

A cancer diagnosis and its treatments hurl all kinds of stressors at our brains. We need to consciously look after it.

About the Author


Tim Baker is an award-winning author, journalist and storyteller specialising in surfing history and culture, working across a wide variety of media from books and magazines to film, video, and theatre. Some of his most notable books include “Occy”, a national bestseller and chosen by the Australia Council as one of “50 Books You can’t Put Down” in 2008, and “The Rip Curl Story” which documents the rise of the iconic Australian surf brand to mark its 50th anniversary in 2019. Tim is a former editor of Tracks and Surfing Life magazines. He has twice won the Surfing Australia Hall of Fame Culture Award.

Tim was diagnosed with stage 4, metastatic prostate cancer in 2015 with a Gleason score 9. He was told he had just five years of reasonable health left, but eight years on, at 58, he’s still surfing, writing, and enjoying being a dad. His latest book, Patting the Shark, also documents his cancer journey and will be published in August. Tim will be sharing weekly insights into his journey to help other men who have also been impacted by prostate cancer.