Testosterone is the primary male hormone, and plays an important role in establishing and maintaining the typical male characteristics, such as body hair growth, muscle mass, sexual desire, and erectile function, and contributes to a host of other normal physiologic processes in the body.
The list of potential effects of testosterone loss is long: hot flashes, decreased sexual desire, loss of bone density and increased fracture risk (osteoporosis), erectile dysfunction, fatigue, increased risk of diabetes and heart attacks/strokes, weight gain, decreased muscle mass, anemia, and memory loss. Cholesterol, especially the LDL cholesterol, tends to rise, and muscle tends to get replaced by fat. Most men who are on hormone therapy experience at least some of these effects, but the degree to which any man will be affected by any one drug regimen is impossible to predict. See the above sections for more detailed descriptions of these side effects and management of them.
Before beginning hormone therapy, every man should discuss the effects of testosterone loss with his doctors, so he can alter his lifestyle to accommodate or head off the changes. Exercise is probably the best thing a man can do to prevent many of these side effects.
Over the years, researchers have explored different ways to minimize the side effects of testosterone loss while maximizing the therapeutic effect of hormone therapy. The most commonly explored strategy is known as intermittent therapy.
This strategy takes advantage of the fact that it takes a while for testosterone to begin circulating again after LHRH agonists are removed. (See the Hormone Therapy section for a review of how the different hormone therapies work.)
With intermittent hormone therapy, the LHRH agonist is used for six to twelve months, during which time a low PSA level is maintained. The drug is stopped until the PSA rises to a predetermined level, at which point the drug is restarted. The “drug holidays” in between cycles allow men to return to nearly normal levels of testosterone, potentially enabling sexual function and other important quality of life measures to return before the next cycle begins again.
At this time, however, the true benefits of this approach remain unclear, and large clinical trials are currently underway to evaluate its use in men with advanced prostate cancer. If the approach proves to be as effective as continuous therapy in suppressing tumor growth, intermittent therapy will likely become popular because of potential for an improved side effect profile.
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