Many normal cells also rely on testosterone to remain healthy. Side effects occur because the lack of testosterone affects normal cell function.

Not all of these side effects will occur in every man. Many of them are very mild. Some men will have particular problems with one but not another side effect. However, the ‘Big 3’ effect almost every man.

Some side effects include:

Hot flushes:

A feeling of suddenly being hot and/or sweaty may occur and your face may go red. It usually only lasts a few minutes and some men get one every few days. Others get many hot flushes every day and they tend to be worse in hot weather. Hot flushes usually reduce in frequency and severity with time however if they are bothersome treatment is available. As a first line treatment a tablespoon of flaxseed oil daily may help. If this fails to help then there are other prescribed medications which may reduce the hot flushes.

Depression:

Only some men get this. Sometimes it is due to the fact that they have prostate cancer and the issues associated with this. However, about 1 in 10 men get depressed from the ADT itself. If you feel depressed, please tell your doctor as treatment such as a short course of anti-depressants can sometimes help.

Sex drive and erections:

All men will loose their libido or desire for sexual activity. Many men already have their ability to get erections affected by other prior therapy for prostate cancer or illness. However, ADT will almost always prevent men from being able to have an erection. Unfortunately there is no effective therapy to prevent this currently. Viagra or similar may work in a small number of men.

Enlarged painful breasts:

A small number of men will develop painful tender breast. If it does occur and is troublesome, treatment is available.

Weight gain:

On average, men gain 2 to 5 kg with hormone therapy. Weight gain happens in the first 9 to 12 months of therapy. Diet and exercise can assist in the management of weight gain.

Loss of muscle strength:

Most men complain of some degree of loss of strength. It varies considerable from man to man and it does not usually affect how men function physically.

Decreased size of penis and testis:

These organs need testosterone in normal levels to maintain them in a healthy state. ADT will cause the penis and testis to reduce in size noticeably in the first 12 months.

Hair loss:

Loss of chest and arm hair is common. The hair on your head and pubic areas remains the same.

Aches and pains:

Some men complain of muscle and joint aches which come and go and are not severe. Men who are on ADT because their prostate cancer has spread to the bones, often worry that these symptoms indicate that the prostate cancer is progressing but this is usually not the case and is simply a side effect of the hormone therapy.

Thinning of bone:

Men on ADT lose bone similar to a women going through menopause. Some can even develop osteoporosis and therefore be at risk of bone fracture, particularly in the back (vertebrae) and hips. You are at particular risk if you smoke, drink more than 2 glasses of alcohol a day, need ADT for more than a few years, have low calcium or vitamin D in your diet and do not exercise. Bone density tests should be performed each 12 months and if you have significant bone loss then specific therapy may be recommended.

Anaemia:

This is a reduction in the red blood cells. It cannot be fixed by taking iron tablets though is usually mild and does not cause any problems. If it becomes severe, other causes should be looked for such as iron or vitamin B deficiency or blood loss.

Cholesterol and Triglyceride:

Sometimes these become elevated in the blood of men taking ADT. If the levels become very high you may need treatment. Men who have high cholesterol and triglyceride levels before treatment are especially at risk.

Worsening of diabetes or lung disease:

ADT affects your insulin levels in the body and may worsen the control of diabetes. Men with severe lung disease may feel their breathing worsen. This is probably due to weakness of the chest muscles and the mild anaemia which wouldn’t normally affect men without lung problems.

Tiredness and lack of energy:

Most men feel more tired and don’t have as much energy as usual. Some men say that they feel that they have 80 to 90% of their normal energy.

Lack of initiative, lack of concentration:

Some men say that they don’t feel as ‘sharp’ as normal, especially if they are in a job that requires a lot of concentration.

Mood swings:

Some men feel more emotional than usual. They may have a ‘short fuse’ or may get upset about things that would not normally bother them.