Androgen deprivation therapy (ADT) is a cornerstone treatment for advanced prostate cancer, designed to reduce testosterone levels—the hormone that fuels tumor growth. By depriving cancer of its primary fuel, ADT can help shrink tumors, prevent new growth, and even improve survival rates, including in men with metastatic disease.
However, medical experts warn that lowering testosterone can trigger significant side effects. “Depleting testosterone creates a lot of systemic side effects,” says Dr. Joseph Renzulli, associate professor of urology at Yale School of Medicine. “ADT has a substantial impact on men, particularly those on long-term therapy.”
Here are five common side effects of ADT and strategies for managing them:
1. Fatigue
Fatigue is among the most frequently reported side effects, especially during the first year of therapy. Exercise—particularly resistance training—can help increase energy levels while preserving muscle and bone health. Experts recommend aiming for at least 30 minutes of activity daily.
2. High Blood Sugar
ADT may double the risk of developing type 2 diabetes, likely due to increased body fat and insulin resistance associated with reduced testosterone. Patients should monitor blood sugar levels and adopt a diet rich in lean proteins and plant-based foods while limiting added sugars and processed foods.
3. High Blood Pressure and Cholesterol
Testosterone suppression can elevate blood pressure and cholesterol. A collaborative approach with oncologists, primary care doctors, and cardiologists is recommended. A heart-healthy diet, regular physical activity, and limiting alcohol intake can support cardiovascular health, alongside medical interventions when needed.
4. Weak Bones
Testosterone helps maintain bone strength, and ADT can accelerate bone loss, increasing fracture risk. Vitamin D and calcium supplementation is often advised, while bone protection agents (BPAs) such as bisphosphonates or monoclonal antibodies may be prescribed to restore bone density. Bone loss can begin within six months of starting therapy.
5. Sexual Dysfunction
Lower testosterone levels often result in decreased libido and erectile difficulties. While medications for erectile dysfunction may help some patients, psychological support—including cognitive behavioral therapy (CBT) and sensate focus techniques—can improve sexual function, intimacy, and overall quality of life. Open communication with partners is also crucial.
Monitoring and Follow-Up
Many side effects may resolve after treatment ends, but some men remain on ADT for life, continuing to experience these effects. Regular follow-ups with physicians, along with support from mental health specialists when necessary, are key to managing both physical and emotional challenges associated with therapy.
Takeaway
ADT is effective in controlling prostate cancer, but patients should be aware of potential side effects such as fatigue, bone loss, high blood sugar and blood pressure, and sexual dysfunction. Maintaining an active lifestyle, following a nutritious diet, and communicating closely with healthcare providers can help mitigate these impacts and enhance quality of life during treatment.
READ MORE
