Side Effects of Hormone Therapy

Common side effects of hormone therapy.

side effects of hormone therapySide effects of hormone therapy, which occur when levels of the serum testosterone are lowered, can have many impacts on day-to-day life and many men are afraid of such treatments.  Sexual dysfunction, loss of libido and erectile dysfunction are all side effects of hormone therapy. Bone health is also an issue. If untreated, long term hormone deprivation can lead to osteoporosis and bone loss. Generalized fatigue and loss of muscle are also side effects of hormone therapy.

When considering the management of side effects of hormone therapy, doctors attempt to distinguish between side effects that affect the patient’s quality of life, but are not life threatening and those that can potentially effect the patient’s health and survival.

Farshid Dayyani, MD:  Hormone deprivation therapy meaning the lowering of serum testosterone has many known side effects and a lot of men are afraid of those.  Let’s talk about how to best manage those.

The main side effects observed with hormone deprivation therapy are directly linked to lowering the serum testosterone and its effects.  Obviously, sexual dysfunction, loss of libido and erectile dysfunction are associated and most concerning for majority of men treated with this modality.

Bone health is another issue. If untreated, long term hormone deprivation will lead to osteoporosis and bone loss. Hot flashes are not very dangerous, but affect the quality of life of the patients.

There is generalized fatigue, there is loss of muscle, and may be clinically more important, we have seen that hormone deprivation long term is associated with dysregulation of cholesterol, of increasing blood sugars and there has been some suggestion that a cardiovascular risk might also be increased.

So, when we are talking about managing the side effects, we have to distinguish between those that affect the patient’s quality of life, but they are not life threatening and those that are potentially affecting the patient’s health and survival.  For sexual dysfunction, what we do recommend is prior to initiation of therapy, counselling with a sexual counsellor to prepare the patient and his spouse if indicated for the side effects that will be encountered.  This has been shown to help with coping of the patients.  In terms of bone loss, we do recommend dietary calcium and vitamin D intake daily, regular exercise and specific bone targeted agents that are approved for this indication such as denosumab.

Generalized fatigue is difficult to treat with medication, but we do recommend regular exercise four to five times a week for about 45 minutes which has been shown to help with that regard.  In terms of more serious side effects such as metabolic syndrome, hyperlipidemia, glucose intolerance, these are factors that should be known and actively managed by your treating physician meaning regular blood tests and initiation of appropriate medication if for example, your cholesterol levels are going up.

If you look at the actual risk for cardiovascular disease and death, the link is less strong than some people might think.  In the largest trials, if you combine them and look, there were actually not more cardiovascular deaths observed compared to controls.  So, while it is important to control the blood sugar and cholesterol, it is important for patients to know and put into perspective the right risk benefit of treatment of their prostate cancer with hormone deprivation.

Farshid Dayyani
Dr. Dayyani earned his medical degree in Munich, Germany at Ludwig-Maximilians Universitaet before completing his internal medicine internship and residency at Beth Israel Deaconess Medical Center in Boston, Mass.
Farshid Dayyani

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