Androgen Deprivation Therapy

Overview

Androgen deprivation therapy (ADT) is a treatment that lowers or blocks the male hormones your body makes — mainly testosterone. Androgens are often called 'male hormones'. They help prostate cells grow, and prostate cancer cells need them to survive and spread. By cutting off that fuel supply, ADT can slow or shrink prostate cancer. It is not a disease in itself and it does not cure cancer on its own, but it is a very important part of treatment for many people. It is also sometimes used for other reasons, always under specialist care.

Yes. ADT is one of the most common treatments for prostate cancer worldwide, and millions of people have had it. Your care team will be very familiar with how to manage it and its side effects.

It is used mostly in men with prostate cancer, and the risk of prostate cancer rises with age, so many people having ADT are older. It can also be used in younger men, and very occasionally in children or teenagers for specialist hormone-related reasons. The side effects can feel different depending on your age, your other health conditions, and how long you take the treatment.

Symptoms

Common symptoms

• Hot flushes and sweating, often most noticeable in the first few months
• Feeling more tired than usual or having less energy
• Lower sex drive and changes in erections
• Smaller testicles and some loss of muscle
• Weight gain, especially around the belly
• Mood changes such as low mood, irritability or feeling emotional
• Trouble sleeping, and sometimes 'brain fog' — being more forgetful or finding it harder to concentrate
• Breast tenderness, or slight growth of breast tissue
• Bones getting thinner and weaker over time, which raises the chance of a break
• Smaller body hair growth, and softer skin

Symptoms in children

• ADT is only very rarely used in children, and only under a specialist team
• If it is used, it can slow or pause puberty, so growth, mood, bone strength and school life are checked closely
• Parents and children are given time to talk through the reasons, the risks and the alternatives before any treatment starts

Symptoms in older adults

• Tiredness and loss of muscle can make falls more likely, so strength and balance exercise matters
• Bone thinning matters more if you already have weak bones, so bone checks are important
• Heart and blood sugar problems are more likely if you already have them, so regular checks help
• Memory and concentration changes can be more noticeable, and are worth mentioning to your team
• Side effects can add to other medicines you take, so ask your pharmacist to review them

Causes

Main causes

• ADT is a treatment, not an illness, so it does not have a 'cause' in the usual sense. It is prescribed when lowering male hormones is likely to help.
• Most often it is used to treat prostate cancer, because prostate cancer cells depend on male hormones to grow.
• It is often given together with radiotherapy to make the radiotherapy work better.
• Sometimes it is used before certain treatments to shrink an enlarged prostate, or to control symptoms if cancer has spread.
• Rarely, it is used for other hormone-related conditions, always under specialist care.

Risk factors

• Being older, or already having heart disease, high blood pressure or diabetes
• Already having thin bones (osteoporosis), or a family history of broken bones
• Smoking
• Not being physically active
• Longer courses of treatment
• Drinking a lot of alcohol
• Already feeling low in mood or anxious before starting

When to see a doctor

See a doctor urgently if:

• Severe back pain with weakness, numbness, or problems with your bladder or bowels
• Chest pain, sudden breathlessness, or signs of a stroke
• A fever with feeling very unwell
• Being unable to pass urine
• Thoughts of harming yourself or feeling unable to cope
• A hot, red, swollen or painful leg

Book a routine appointment if:

• Side effects that are bothering you, even if they seem small — there is often something that can help
• Low mood, anxiety, or changes in sleep that last more than a couple of weeks
• New aches in your bones
• Any new medicine, supplement or herbal remedy you have started, so your team can check it is safe with your treatment
• Questions about how long your treatment will last, or whether a break is possible

Diagnosis

ADT is not something you are 'diagnosed' with — it is a treatment your specialist recommends after tests show it is likely to help. Before you start, your team does a set of baseline checks. These give a picture of your health before treatment, so any changes later can be spotted early and managed.

Tests that may be done

• A blood test to measure your testosterone level
• A PSA blood test — PSA is a protein made by the prostate, and the level helps show how the prostate is doing
• Routine blood tests including blood count, liver and kidney function, blood sugar and cholesterol
• Blood pressure, weight and waist measurement
• A bone density scan, a quick and painless X-ray type test that measures how strong your bones are
• Sometimes a heart check such as an ECG, especially if you have heart problems
• Scans such as MRI, CT or a bone scan to see the full picture of the cancer
• Questions about your mood, sleep, sex life and general fitness, so support can be planned

What to expect at your appointment

You will usually have a conversation with your specialist team about why ADT is being suggested, what the alternatives are, and what to expect. If you go ahead, you will be given a schedule — for example an injection every few months — plus follow-up appointments to check your hormone level, PSA, blood pressure, bones and mood. Write down your questions beforehand; it is completely fine to take someone with you or to ask for more time to decide.

Treatment

ADT works by switching off or blocking the signals that tell your body to make testosterone. There are several ways to do this, and your team will suggest the one that fits your situation. Some people have a short course of a few months; others have it for years. Some people have treatment in cycles, with planned breaks. There is no single 'right' plan — it depends on why you are having it, how well it is working and how you are feeling.

Self-care at home

• Stay active — a mix of walking, strength work and balance exercise helps protect your muscles, bones and mood
• Eat well, with plenty of vegetables, beans, whole grains and protein, and watch portion sizes if you gain weight
• Look after your bones: enough calcium and vitamin D from food or a supplement your team suggests, plus weight-bearing exercise
• Stop smoking if you can, and keep alcohol within low-risk limits
• Protect your skin from the sun and use moisturiser if treatment makes it dry
• Keep cool and dress in layers to help with hot flushes; cut down on caffeine, alcohol and spicy food if they trigger them
• Keep a simple diary of side effects to share at appointments
• Stay connected with friends, family and any groups you enjoy

Medical treatments

There are three main approaches. First, regular injections or small implants under the skin, given every few months, which tell the body to stop making testosterone. Second, tablets that block testosterone from working or stop the body making it — some are taken daily. Third, surgery to remove the testicles, which lowers testosterone straight away. Your specialist may also suggest other medicines or support for specific side effects, such as bone protection, help with hot flushes, or treatment for low mood. Always ask your team or pharmacist before starting anything new, including herbal remedies, because some can interfere with treatment.

When is surgery considered?

Surgery is one option for lowering testosterone and is called orchiectomy — removal of the testicles. It is a small operation, usually done under a general anaesthetic, and it lowers hormone levels quickly and permanently with no need for ongoing injections. It is not right for everyone, and many people prefer injections. It is a personal choice, and your surgeon will explain the pros and cons, including that it cannot be reversed and that it does not affect your ability to have sex or pass urine in the way you might worry it does — but it does remove the body's own testosterone supply for good.

Living with this condition

Most people carry on with work, family life and hobbies during ADT, but you may need to pace yourself more than before. Plan demanding tasks for when your energy is best, keep a regular sleep routine, and build short rests into busy days. Hot flushes can be awkward in meetings or at night — layers, a fan and a cool drink help. Give yourself time to adjust; the first few months are often the trickiest, and many people find a new rhythm.

Lifestyle tips

• Aim for some movement every day, even a short walk
• Add strength work two or three times a week — resistance bands, light weights or body-weight exercises
• Practise balance exercises to reduce the chance of falls
• Keep to a healthy weight and get your blood pressure checked regularly
• Limit alcohol and avoid smoking
• Stay socially connected — isolation makes side effects feel worse
• Keep up with hobbies and things that give you a sense of purpose

Diet and exercise

There is no special diet that ADT requires, but a healthy pattern helps a lot. Base meals on vegetables, fruit, beans, lentils, whole grains and lean protein such as fish, chicken, eggs or tofu. Choose healthy fats like olive oil and nuts, and go easy on sugary drinks and heavily processed food. Calcium-rich foods such as milk, yoghurt, tinned fish with bones and leafy greens help your bones. Aim for at least 150 minutes of moderate activity a week, spread out, plus two strength sessions. If exercise feels daunting, start small and build up — your team may be able to refer you to a supported exercise programme.

Mental health and emotional wellbeing

Low mood, irritability, worry and a sense of losing your 'edge' are common on ADT, and they are not a sign of weakness. Hormone changes affect mood directly, and dealing with cancer adds its own strain. Talk about how you feel — with your team, a counsellor, or people you trust. If you ever have thoughts of harming yourself or feel you cannot cope, please reach out for crisis support straight away, either through your local emergency number or a crisis line in your country. You deserve help quickly, and it is available.

Prevention

ADT is a treatment, so it cannot be prevented — but many of its side effects can be reduced or avoided. Keeping active, eating well, not smoking, protecting your bones and getting your blood pressure, blood sugar and mood checked regularly all make a real difference. Ask your team early about bone protection and heart health rather than waiting for problems to appear.

Vaccines

There is no vaccine for ADT. Keep up with routine vaccinations your doctor recommends, and ask your team about flu and other seasonal vaccines, as staying well matters while you are having treatment.

Screening programmes

While you are on ADT you will have regular monitoring rather than screening. This usually includes blood tests for testosterone and PSA, blood pressure and weight checks, and periodic bone density scans. Your team may also check your blood sugar and cholesterol, and ask about your mood. Keep to these appointments even if you feel well — they catch problems early when they are easiest to deal with.

Complications

If left untreated

• If the cancer ADT is meant to treat is not treated, it can grow and spread, which may cause pain, urinary problems or other symptoms
• Unmanaged side effects can add up: bones can become thin enough to break easily, and muscle loss can affect balance and independence
• Heart and blood sugar problems are more likely if they are not monitored
• Low mood and anxiety can deepen if they are not talked about or treated
• Sexual and relationship difficulties can become harder to address the longer they are left

Long-term outlook

For most people, ADT is a manageable treatment that does its job well. Side effects are common but there is a lot that can be done to reduce them, and many people live full, active lives during and after treatment. Your team can adjust the plan — including changing the type of treatment or building in breaks — if side effects are hard. Talk openly about how you are doing, and remember that support is there whenever you need it.

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