Like most medicines, hormone therapy for prostate cancer can cause side effects. The treatment affects men in different ways. You may deal with a lot of bad side effects or just a few mild ones. It really depends. The longer you’re on hormone therapy, the more likely you are to have issues.
While side effects from hormone therapy are common, you can manage them with lifestyle changes, medications, and other strategies. You might also find that your side effects become easier to deal with over time.
Why Does Hormone Therapy Cause Side Effects?
One word: testosterone. To fight prostate cancer, hormone therapy lowers levels of testosterone in your body. When your testosterone drops, prostate cancer cells don’t get the fuel they need to grow. But this can also cause other, unwanted changes. Testosterone is important for your muscles, bones, mood, sexual health, and energy levels. With less testosterone, your body reacts in ways that can make you feel bad.
How Long Do Side Effects Last?
Side effects usually last as long as you are on the medicine. If you stop treatment with hormone therapy, your testosterone levels will eventually go back up. This means you’ll notice fewer problems. But it doesn’t happen overnight. It can take several months before all your side effects go away completely after you quit hormone therapy.
What are Some Common Side Effects of Hormone Therapy?
Hot flashes
About 70%-80% of men who take hormone therapy have hot flashes. A hot flash is essentially a sudden feeling of warmth or flushing. You might also sweat and turn red. These symptoms are mostly felt in your face, head, and upper body. Most hot flashes last around four minutes. They are usually worse at night. It’s also common to have a cold sweat when the hot flash is over.
Loss of sex drive
You may notice that you aren’t interested in sex while you’re on hormone therapy. That’s because you have less testosterone, which controls your sex drive. Some men also report that they have less intense orgasms while on hormone therapy. And hormone therapy can make your penis shorter and alter the size of your testicles. These changes can affect your relationships and your self-esteem.
Erectile dysfunction
Hormone therapy can make it difficult to get or keep an erection. This problem is called erectile dysfunction (ED). Sometimes, ED can be permanent. It depends on the type of hormone therapy you take and how long you’ve been on it. Other cancer treatments, like surgery and radiation, can also cause ED.
Tiredness
Hormone therapy can make you feel very tired, which can affect your energy levels and motivation. This extreme tiredness can come on suddenly. You should be careful when you drive a car or do other things that require you to be alert.
Loss of muscle mass
Testosterone helps build and maintain the muscles in your body. Without a lot of the hormone, you might lose muscle mass. This can change how you look and feel. With less muscle, you may not be as physically strong as you once were. You also might notice joint pain or muscle aches.
Weight gain
Weight gain is another side effect of hormone therapy. You might notice most of the extra pounds build up around your waist. Many men find this change hard to deal with, especially if they’ve never had weight issues in the past.
Heart problems and diabetes
Hormone therapy can up your risk of heart-related problems. When you have less testosterone in your body, cholesterol and sugar levels in your blood tend to go up. These changes, along with weight gain and less muscle mass, are linked to type 2 diabetes, heart attacks, strokes, and heart failure. The longer you take hormone therapy, the higher your chances of heart disease.
Breast changes
You might notice breast changes while you’re on hormone therapy. These include issues like swelling and tenderness. The swelling can cause breasts to get bigger. They may appear somewhat larger or, sometimes, noticeably bigger. Breast tenderness can range from mildly sensitive to persistently painful.
Anemia
Anemia, or a low red blood cell count, is a common side effect of hormone therapy. A simple blood test can tell your doctor if you have this condition. Anemia can cause you to feel weak, tired, dizzy, or short of breath.
Depression
Hormone therapy can change your mood and, sometimes, lead to depression. You might feel more sensitive or cry a lot. One study found that men with prostate cancer who had hormone therapy were 23% more likely to develop depression than those who didn’t receive hormone therapy.
Bone thinning
If you take hormone therapy for a long time, you may develop thinning bones. That’s because the treatment lowers testosterone, which helps maintain bone strength. Sometimes, bone thinning can lead to osteoporosis (a condition that causes bones to become weak and brittle) or broken bones.
Other symptoms
Some other symptoms that hormone therapy may cause are:
- Diarrhea
- Nausea
- Loss of body hair
- Changes in memory or concentration
How Can You Help Lessen Side Effects?
Fortunately, there are some steps you can take to help with side effects of hormone therapy. The first step is to talk to your doctor about your options.
Intermittent dosing
Some men follow a plan called intermittent dosing to help ease side effects. This means you stop hormone therapy for a period of time when your blood markers are low. Then, you can pick it up again when your numbers start to rise. While this method may work for some men, others don’t notice a change during the relatively short amount of time they go off the meds. Also, there’s a chance your cancer can grow while you take a break from hormone therapy. Your doctor can help you decide if this is a good option.
Medications
Certain medications can help with different side effects. Here are some examples:
- Antidepressants can help relieve symptoms of depression, anxiety, or other mood changes.
- Some medicines may help ease hot flash symptoms. Your doctor may suggest gabapentin, medroxyprogesterone, paroxetine, or venlafaxine.
- Certain treatments, such as bisphosphonates or denosumab (Prolia, Xgeva), can help improve bone thinning caused by hormone therapy.
- The medicine tamoxifen may help prevent or treat breast swelling or tenderness.
- Some drugs, creams, or devices might be helpful if you have a low sex drive or ED.
Lifestyle changes
Certain lifestyle habits can help you manage the side effects of hormone therapy.
Regular exercise can improve a lot of different symptoms. It can enhance your mood, prevent bone and muscle mass loss, promote a healthy weight, lower your risk of heart issues, and boost your energy levels. Talk to your doctor about what kind of exercise program would be best for you.
If you notice symptoms of depression or mood swings, yoga, mindfulness, or listening to music could help you feel more relaxed.
To cope with hot flashes, try these steps:
- Stay hydrated. Aim for about six to eight glasses of water a day.
- Steer clear of smoking, alcohol, and caffeine.
- Avoid spicy foods.
- Wear light clothing to bed.
- Keep your room cool.
- Don’t take hot showers.
Here are some strategies to help with bone thinning:
- Eat lots of calcium and vitamin D to support strong bones. Calcium is found in dairy products, tofu, and green, leafy veggies. Foods that are rich in vitamin D are oily fish like salmon and some breakfast cereals.
- Avoid too much alcohol.
- Don’t smoke.
- Maintain a healthy weight.
If you want to lower your risk of heart-related issues, be sure to:
- Eat a healthy diet and exercise regularly.
- Limit your salt intake.
- Don’t smoke.
- Cut down on alcohol.
Radiation
Low-dose radiation therapy can lessen swelling and tenderness in your breasts. But it has to be done quickly – within a month of starting hormone therapy. It may not help reduce breast size once swelling has already started, but it may lessen tenderness and pain. Radiation has its own side effects, which may include hair loss and red, dark, or irritated skin.
Show Sources
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SOURCES:
Prostate Cancer UK: “How hormone therapy affects you.”
MedlinePlus: “Hormone therapy for prostate cancer.”
Harvard Health: “Hot flashes in men: An update,” “Can hormone therapy cause muscle loss?”
Cancer Research UK: “Side effects of hormone therapy in men.”
Fred Hutch Cancer Center: “Hormone Treatment Side Effects.”
American Heart Association: “Close monitoring for heart risk needed if breast, prostate cancer treatment includes hormones.”
American Cancer Society: “Hormone Therapy for Prostate Cancer.”
Mayo Clinic: “Anemia.”
Urologic Oncology: “Decreasing suicide risk among patients with prostate cancer: Implications for depression, erectile dysfunction, and suicidal ideation screening.”
National Cancer Institute: “Hormone Therapy for Prostate Cancer.”
UpToDate: “Patient education: Gynecomastia (breast enlargement in males) (Beyond the Basics).”
