So, what are the most common side effects of hormone therapy?
Well, there's—the three big ones are loss of muscle which causes fatigue, loss of libido
(which is loss of sex drive; it doesn't mean incapacity to have erections because men can
take Viagra), and the third one is slow metabolism and potential for weight gain. Those are the
big three. I talk about those as the big three because those are sometimes the hardest to
manage. There's a lot of other things such as osteoporosis, breast enlargement, dry skin,
other things that we have treatment for and generally don't present a problem if the doctor
managing it is expert enough to know how to prevent them.
In regard to breast enlargement, how do you mitigate that side effect?
So, there's a medicine that blocks estrogen—FDA-approved for the treatment of breast cancer—called
Femara. It's very effective. One pill a day. Other things that can be done: a little radiation
to the breast area will prevent the breast enlargement. So, with those measures, that
doesn't usually present a problem.
Okay, so in regard to fatigue, how do you handle that?
So, the number one thing that I always get men to sign in blood at the beginning of their
treatment for hormone therapy is to start resistance training with weights, preferably
under the supervision of a trainer. And if men will commit to that type of a program,
say three days a week in the gym or under supervision lifting weights, they'll feel
pretty normal throughout the treatment period. Those that compromise or take holidays will
lose muscle so fast it'll make their head swim and they'll feel tired and fatigued and
then you have to crawl back up the mountainside again. So, weight training is the number one
thing I emphasize when men go on this treatment.
I know one thing I've heard you mention that I've also seen work for a lot of men is also
getting a personal trainer to help keep them accountable. I've seen that be very effective
in many many patients.
It helps. It's not an easy thing to accomplish and having someone to encourage you and supervise
you makes a big difference.
So, when it comes to the loss of libido, do you have a certain set of suggestions for
the patients that they can pay attention to in order to kind of help maybe their relationship
or the process?
Well, we certainly want to advice the couples, sometimes the spouse may not realize that
the man's change is nothing to do with their relationship. It has to do with just the hormones
and then also because people's libidos are low they forget that they need to get regular
erections throughout the time period that they're on the therapy. So, low libido doesn't
mean that men shouldn't be taking some Viagra and maintaining normal sexual erections at
least once or twice a week basis, otherwise atrophy can set in.
So, something that I don't know that we've mentioned is hot flashes. I know that we did
a survey with PCRI and it shows that I think about 90% of men who experience—or are on
hormone therapy are experiencing hot flashes. So, what can they do to mitigate that? Is
that normal... and is there anything that they can take?
There are things to take. Sometimes men are a little fed up with taking so many pills
and they just endure the hotflashes. They're not dangerous. Sometimes they're so intrusive
that people have trouble sleeping at night, and if that happens, medicines—there's an
antidepressant medicine called Effexor, small dose, 30MG can be helpful. Or another medicine
that's used for sometimes for seizures in small doses called Neurontin can help with
hot flashes. Acupuncture can help with hot flashes. There's a need for better medicines.
None of these measures are 100% effective. The most effective treatment is estrogen.
Usually, we give a small patch, an estrogen patch, and that will make the hot flashes
go away. But then there's a little bit of risk of breast enlargement then. So, it's
a tricky area and we're still hoping for new and better agents to help men in this area.
Thanks for watching! If you would like more information about any of the topics we discussed
today, you can go ahead and visit our website at PCRI.org, and go ahead and subscribe to
our YouTube channel. We post new prostate cancer videos every week.