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.

Intermittent Therapy

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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Terms to know from this article:

Hormone

A chemical made by glands in the body. Hormones circulate in the bloodstream and control the actions of certain cells or organs. Some hormones can also be made in a laboratory.

Osteoporosis

A condition that is characterized by a decrease in bone mass and density, causing bones to become fragile.

Tumor

A mass of excess tissue that results from abnormal cell division. Tumors perform no useful body function. They may be benign (not cancerous) or malignant (cancerous).

Side Effect

A problem that occurs when treatment affects tissues or organs other than the ones being treated. Some common side effects of cancer treatment are fatigue, pain, nausea, vomiting, decreased blood cell counts, hair loss, and mouth sores.

PSA

prostate-specific antigen (PSA): A substance produced by the prostate that may be found in an increased amount in the blood of men who have prostate cancer, benign prostatic hyperplasia, or infection or inflammation of the prostate.

Hormonal therapy

Treatment that adds, blocks, or removes hormones. For certain conditions (such as diabetes or menopause), hormones are given to adjust low hormone levels. To slow or stop the growth of certain cancers (such as prostate and breast cancer), synthetic hormones or other drugs may be given to block the body's natural hormones. Sometimes surgery is needed to remove the gland that makes hormones. Also called hormone therapy, hormone treatment, or endocrine therapy.

Lymph

The clear fluid that travels through the lymphatic system and carries cells that help fight infections and other diseases. Also called lymphatic fluid.

Biopsy

The removal of cells or tissues for examination under a microscope. When only a sample of tissue is removed, the procedure is called an incisional biopsy or core biopsy. When an entire lump or suspicious area is removed, the procedure is called an excisional biopsy. When a sample of tissue or fluid is removed with a needle, the procedure is called a needle biopsy or fine-needle aspiration.

Progression

Increase in the size of a tumor or spread of cancer in the body.

Immunotherapy

Immunotherapy is a type of treatment that boosts or restores the immune system to fight cancer, infections and other diseases. There a several different agents used for immunotherapy; Provenge is one example.

androgen

A type of hormone that promotes the development and maintenance of male sex characteristics.

Orchiectomy

Surgery to remove one or both testicles.

urologist

A doctor who has special training in diagnosing and treating diseases of the urinary organs in females and the urinary and reproductive organs in males.

Goserelin

A drug that belongs to the family of drugs called gonadotropin-releasing hormone analogs. Goserelin is used to block hormone production in the ovaries or testicles.

Zoladex

Trade or brand name for goserelin acetate, an LHRH used in hormone therapy.

Degarelix

And FDA approved hormonal therapy for advanced prostate cancer. Degarelix blocks the action of gonatotropin-releasing hormone (GnRH) receptors and results in suppression of testosterone production. Belongs to a class of drugs called GNRH-antagonists or LHRH-antagonists (Leutinizing hormone-releasing hormone).

Flare

A sudden reaction to starting hormone therapy, sometimes characterized by severe increase in pre-hormone therapy symptoms, such as pain; does not occur in all men; some report it may be prevented by taking an anti-androgen (Casodex, Nilandron) several days before starting hormone therapy.

Flutamide

An anticancer drug that belongs to the family of drugs called anti-androgens. Flutamide use has been largely replaced by newer anti-androgen drugs including Enzalutamide.

Abiraterone

Abiraterone acetate (Zytiga) is an oral medication that blocks the synthesis of androgens (male hormones), such as testosterone, inside the tumor. Abiraterone is FDA approved for the treatment of patients with metastatic castrate resistant prostate cancer.

Anti-androgen

A drug used to block the production or interfere with the action of male sex hormones.

Refractory

In medicine, describes a disease or condition that does not respond to treatment.