Why does hormone therapy cause side effects?
Contents
Living with prostate cancer

How hormone therapy affects you

Are you living with side effects? Your voice matters!

We are carrying our important research into the psychological and social impacts of living with treatment-related side effects.

Life after prostate cancer treatment…Your voice matters!

Like all treatments, hormone therapy can cause side effects. Make sure you discuss these with your doctor or nurse before you start treatment. You can also talk to our Specialist Nurses about side effects.

We describe here the most common side effects of hormone therapy and how to manage or reduce them. It may seem like there are a lot of possible side effects, but you may not get all of them. Hormone therapy affects men in different ways. Some men have fewer side effects than others. This doesn’t mean that the treatment is any less effective.

There are treatments and support to help manage side effects. And some men find that their side effects get better or become easier to deal with over time. The risk of getting each side effect depends on your type of hormone therapy and how long you take it for. If you have hormone therapy alongside another treatment, you may get side effects from both treatments.

Download or order Living with hormone therapy booklet

Why does hormone therapy cause side effects?

If testosterone is taken away or blocked by hormone therapy, prostate cancer cells will usually shrink, wherever they are in the body. But reducing or blocking testosterone can cause other things to change in your body too.

Testosterone controls the development and growth of the sexual organs, including the prostate, and affects the way you think and feel. It also controls other male characteristics, such as erections and muscle strength. So when testosterone is reduced, or taken away by hormone therapy, all of these things can change.

The diagram below shows how testosterone affects a man's body. Knowing this can help you understand what side effects you might get when you're having hormone therapy.

How testosterone affects a man's body

The side effects of hormone therapy are caused by lowered testosterone levels. Side effects will usually last for as long as you are on hormone therapy. If you stop your hormone therapy, your testosterone levels should gradually rise again and some side effects will reduce. Your side effects won’t stop as soon as you finish hormone therapy – it may take several months to several years.

Surgery to remove the testicles (orchidectomy) can’t be reversed, so the side effects are permanent. But there are treatments that can help reduce or manage some of the side effects.

What are the side effects?

Hot flushes

Hot flushes are a common side effect of hormone therapy. They give you a sudden feeling of warmth in your body. You might feel very hot in your face, neck, chest or back. They can vary from a few seconds of feeling very hot to a few hours of sweating, which can be uncomfortable. Read more about hot flushes, including ways to help manage them.

Extreme tiredness (fatigue)

Hormone therapy can make you feel extremely tired, which could affect your everyday life. Fatigue can come on quite suddenly and can make it difficult to carry out your daily activities. It can also affect how you feel emotionally, and you may feel down. But there are things that can help manage your fatigue. Read more about fatigue and prostate cancer, and ways to manage it. 

Changes to your sex life

Having hormone therapy affects your sex life in different ways. In most cases, these changes last for as long as you are on hormone therapy. It can take up to a year or longer for sexual function to gradually return to normal after stopping hormone therapy. But some men don’t see an improvement after stopping hormone therapy. And if you’ve had surgery to remove the testicles (orchidectomy), these side effects can’t be reversed.

Not everyone will have all the same side effects, but possible changes to your sex life may include the following.

  • Less desire for sex (low libido). Hormone therapy will change your sex drive and may mean that you have less interest in sex. This is because hormone therapy lowers your level of testosterone, which is what gives you your sex drive.
  • Erection problems. Hormone therapy can cause problems getting or keeping an erection, known as erectile dysfunction (ED). This is less likely if you’re taking anti-androgen tablets on their own. Your GP or doctor or nurse at the hospital can prescribe treatment.
  • Changes to ejaculation and orgasm. You may notice that you produce less semen while you are on hormone therapy. You should still be able to have an orgasm, but it might feel different to before treatment. Some men have less intense orgasms when they are having hormone therapy.
  • Changes in penis and testicle size. Hormone therapy can make your penis shorter and change the size of your testicles. If you put on weight because of your hormone therapy, you might also find it harder to see your penis. This could mean that you don’t aim so well when urinating. We don’t yet know if these changes improve if you stop having hormone therapy, but early research suggests that your penis length might recover a little.

There are treatments and ways to manage changes to your sex life. Read more about prostate cancer and your sex life.

Weight gain

Some men put on weight while they are on hormone therapy, particularly around the waist. You may find that you start to put on weight soon after starting hormone therapy. Some men find this physical change difficult, particularly if they’ve never had any problems with their weight in the past.

What can help?

Physical activity and a healthy diet can help you stay a healthy weight. But it can take a long time to lose any weight that you put on during hormone therapy. If you are finding it difficult to lose weight, ask your doctor to refer you to a dietitian or weight loss programme. Or you could join a local weight loss group – spending time with other people who also want to lose weight can be motivating. The NHS website has lots of tips on how physical activity and a healthy diet can help you to lose weight.

Strength and muscle loss

Testosterone plays an important role in the physical make up of men’s bodies. Compared with women, men usually have more muscle and less body fat. Hormone therapy can cause a decrease in muscle tissue and an increase in body fat. This can change the way your body looks and how physically strong you feel.

Some men also experience muscle aches or joint pain while they’re on hormone therapy. This can happen when you lose muscle. Talk to your doctor or nurse if you have any pain in your muscles or joints. They can talk to you about ways to manage it.

What can help?

Regular gentle resistance exercise, such as lifting light weights or using elastic resistance bands, can help to prevent muscle loss and keep your muscles strong. Speak to your doctor before you start any exercise. They may be able to refer you to a physiotherapist or a local exercise programme. If you can’t move about easily, a physiotherapist can give you some gentle exercises to do at home.

Some areas have walking groups that you could join, which could help you improve your strength and meet new people. Read more about diet and physical activity for men with prostate cancer.

Changes to your memory and concentration

If you’re having hormone therapy you may find it difficult to concentrate or focus on certain tasks. Some men also say they struggle to remember things as well as they did before having hormone therapy. You may hear this called brain fog. But we don’t know for sure whether any changes are caused by the hormone therapy or by something else, because the evidence isn’t very strong. For example, feeling tired, stressed, anxious or depressed can all affect your memory and ability to concentrate. Problems with memory and concentration can also happen naturally as you get older.

Whatever the cause, you may find problems with memory or concentration very frustrating. If you’re having problems with your memory, talk to your doctor or nurse. They will be able to suggest things that may help.

You might find some of these tips helpful.

  • Try keeping lists or reminder notes.
  • Try to concentrate on doing just one thing at a time.
  • Avoid things that distract you when you need to concentrate on something.
  • Try keeping your mind active – for example, by doing crosswords or other puzzles.
  • Make sure you eat a well-balanced diet. Gentle physical activity might also help.
  • Make sure you get plenty of rest.

Breast swelling and tenderness

Hormone therapy may cause swelling (gynaecomastia) or tenderness in the chest area. The amount of swelling can vary from a small amount to noticeable breasts. Tenderness can affect one or both sides of the chest and can range from mild sensitivity to long-lasting pain. Read more about breast swelling or tenderness. 

Loss of body hair

Some men lose their body hair while they are on hormone therapy. This is because testosterone plays a role in hair growth. So when testosterone is reduced, you might lose some of it. It’s less common to lose hair from your head, but if you do, any hair loss caused by hormone therapy treatment usually grows back if you stop hormone therapy. We need more research to show how common this side effect is.

Bone thinning

Testosterone helps to keep bones strong. Long-term hormone therapy may cause your bones to gradually lose their bulk. LHRH agonists, GnRH antagonists and surgery to remove the testicles (orchidectomy) can all have this effect. This can happen in the first 12 months of beginning treatment and the amount of bone loss may increase the longer you are on treatment. Anti-androgen and oestrogen tablets are less likely to cause bone thinning. Some research suggests the use of newer hormone therapies such as abiraterone or enzalutamide may increase the risk of bone fractures when used alongside other types of hormone therapy. 

If bone thinning is severe, it can lead to a condition called osteoporosis. This can increase your risk of broken bones (fractures).

Your doctor may suggest you have a type of X-ray before you start hormone therapy to check if any areas of bone tissue are already weak. You may hear this called a DEXA (dual energy X-ray absorptiometry) scan or a bone density scan. Some men may also need to have regular scans while they are having hormone therapy. You can talk to your doctor about whether you might need a scan.

What can help?

If you already have osteoporosis, have a family history of osteoporosis or have had fractures in the past, talk to your doctor before you start hormone therapy. You should also tell your doctor about any other medicines you are taking, in case they might increase your risk of osteoporosis. The Royal Osteoporosis Society has more information on their website.

There are a number of lifestyle changes that may help to reduce your risk of bone thinning and osteoporosis.

  • Eat plenty of calcium and vitamin D. Calcium and vitamin D are important for strong bones. You can get calcium from dairy foods (cheese, milk and yoghurt) and non-dairy foods, such as fish where you eat the bones, tofu and green leafy vegetables. Most of your vitamin D is made inside the body when your skin is exposed to sunlight. But it can be difficult for your body to make enough vitamin D, especially in winter. You can also get it from eating oily fish such as sardines, mackerel and salmon, as well as foods with added vitamin D, such as margarine and some breakfast cereals. You may need to take calcium and vitamin D supplements – speak to your doctor about this.
  • Cut down on alcohol. Drinking too much can increase your risk of osteoporosis. Guidelines recommend that men should not regularly drink more than 14 units of alcohol a week.
  • Stop smoking. Smoking can increase your risk of osteoporosis. Speak to your GP for help to stop, or visit the NHS website.
  • Be as active as you can. We don't yet know whether exercise can help to prevent bone thinning in men who are on hormone therapy. But regular exercise may help to keep you strong and prevent falls that could lead to broken bones. Walking, swimming and gentle resistance exercise, such as lifting light weights or using elastic resistance bands, may be particularly good.
  • Keep a healthy weight. Men who are underweight have a higher risk of bone thinning.

Read more about diet and physical activity.

Bisphosphonates are drugs that can be used to treat osteoporosis caused by hormone therapy. They can also be used to treat bone weakness caused by cancer that has spread to the bones (advanced prostate cancer).

Denosumab (Xgeva®) is a drug that can help manage bone thinning caused by hormone therapy. It might be an option if bisphosphonates aren’t suitable for you and you live in England, Wales or Scotland. If you live in Northern Ireland, your doctor may be able to apply to your local Health and Social Care (HSC) trust for you to have denosumab if they think it is suitable for you. You might hear this called an individual funding request.

Risk of other health problems

Evidence suggests that having hormone therapy might increase the chance of developing heart disease, stroke and type-2 diabetes. There is also some research that suggests having hormone therapy can increase your risk of getting blood clots and anaemia. But more research is needed to help us understand the links between these conditions.While the risk of getting these conditions may be worrying, it’s important to remember that hormone therapy helps men to live longer by controlling the cancer.

Research shows that hormone therapy can cause:

  • an increase in weight, particularly around the waist 
  • an increase in cholesterol levels
  • changes in insulin.

Talk to your hospital doctor and GP about how often you should have general health checks. You may be weighed and have your blood pressure checked regularly. You may also have blood tests to check for diabetes and to measure your cholesterol levels. Your GP may suggest you have these checks about every six months. Or you can ask for them yourself at your GP surgery.

If you already have heart problems or diabetes, talk to your doctor before you start hormone therapy. They will work with you to manage these conditions.

What can help?

A healthy lifestyle can help reduce your risk of heart disease, stroke and type-2 diabetes. This includes:

  • eating a healthy diet
  • being physically active
  • limiting the amount of salt you eat
  • stopping smoking
  • cutting down on alcohol.

Read more about diet and physical activity.

How might hormone therapy make me feel?

Hormone therapy itself can affect your mood. You may find that you feel more emotional than usual or just ‘different’ to how you felt before. You may find that you cry more easily or have mood swings, such as getting tearful and then angry. Just knowing that these feelings are caused by hormone therapy can help.

But everyone’s different, you may not get side effects of hormone therapy that impacts emotional wellbeing and how you feel.

You may experience low moods, anxiety or depression. This could be directly caused by the hormone therapy itself, or because you've been diagnosed with prostate cancer. It could also be due to the impact that treatment is having on you and your family. Read more about how hormone therapy can affect your mood, including what can help. 

What will happen while I'm having hormone therapy?

You will have regular check-ups to monitor how well your treatment is working, including regular PSA tests. The PSA test is a simple blood test and is an effective way of monitoring your cancer. Your doctor or nurse will tell you how often you’ll have check-ups. This will depend on the stage of your prostate cancer and any other treatments you are having.

If your PSA level falls and stays low, this usually suggests your treatment has been successful at getting rid of your cancer. How quickly your PSA level falls, and how low, will depend on the treatment you’ve had and will vary from man to man. Your doctor or nurse will keep an eye on any side effects from your treatment. Let them know if there are any changes while you are on hormone therapy, or if you get any new symptoms. If there is a continuous rise in your PSA level, this may be a sign that your cancer has come back. If this happens, there are further treatments available.

If you have advanced prostate cancer and your PSA level falls, this usually suggests your treatment is working. How quickly your PSA level falls, and how low, will vary from person to person. You’ll generally keep having the hormone therapy, even after your PSA has fallen. This is because the hormone therapy is controlling the cancer and if you stop having it, the cancer might grow more quickly.

As well as regular PSA tests, you’ll have other blood tests to see whether the cancer is affecting other parts of your body, such as your liver, kidneys or bones. You may also have scans to monitor how well your cancer is responding to treatment. Your doctor or nurse will also keep an eye on your side effects or symptoms. Let them know if you notice any changes to your health.

If there is a continuous rise in your PSA level, this may be a sign that your hormone therapy is no longer controlling your cancer so well. There are further treatments available, including other types of hormone therapy or a combination of other treatments.

What if I'm struggling with side effects?

There are treatments and support available to help manage side effects. But some men find that their side effects continue to affect their daily life. If this happens, speak to your doctor or nurse. It might be possible to try a different treatment, or to take a break from hormone therapy.

Prostate Cancer UK hosts a Life on Androgen Deprivation Therapy (ADT) class that supports men with prostate cancer living on hormone therapy. You can sign up here.

If you’re on life-long hormone therapy and having problems with side effects, you might be able to have intermittent hormone therapy. This is where you stop hormone therapy when your PSA level is low and steady, and start it again if your symptoms get worse or your PSA starts to rise. It may help to give you a break from some of the side effects, such as hot flushes and sexual problems, and you may feel better in yourself. But it can take several months for side effects to improve, and some men never notice any improvement.

For some men intermittent hormone therapy can be just as effective at treating prostate cancer as continuous treatment. But it isn’t suitable for everyone. And it isn’t an option if you choose surgery (orchidectomy).

There is a risk that having a break from treatment may mean your cancer might grow. Speak to your doctor or nurse about the advantages and disadvantages of intermittent hormone therapy and whether it might be an option for you.

You will need to have your PSA level checked every three months while you’re having a break from treatment. You can have intermittent hormone therapy for as long as it continues to work. Your doctor or nurse will tell you when you need to start treatment again. 

What if I decide to stop treatment?

The side effects of hormone therapy can be difficult to deal with, and some men feel that they want to stop their treatment. If you are thinking about stopping hormone therapy, talk to your doctor or nurse. They will explain how this could affect your cancer and discuss any other possible treatments with you.

If you do stop having hormone therapy, the side effects won’t stop straight away. It may take several months or longer for the side effects to improve.

References

Updated: April 2025 | Due for Review: April 2028

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