How does hormone therapy work?

Hormone therapy can work in two ways – either by stopping your body from making the hormone testosterone, or by stopping testosterone from reaching the prostate cancer cells.

Prostate cancer cells usually need testosterone to grow. Testosterone controls how the prostate grows and develops. It also controls other male characteristics, such as erections, muscle strength, and the growth of the penis and testicles. Most of the testosterone in your body is made by the testicles. A small amount also comes from the adrenal glands, which sit above your kidneys.

Testosterone doesn’t usually cause problems but, if you have prostate cancer, it can make the cancer cells grow faster. If testosterone is taken away or blocked, the cancer will usually shrink, wherever it is in the body.

Hormone therapy alone won’t cure your prostate cancer. If you have hormone therapy on its own, the treatment will aim to control your cancer and delay or manage any symptoms. Hormone therapy can also be used with other treatments, such as radiotherapy, to make them more effective.

Read about all treatments for prostate cancer.

Watch our video about hormone therapy to find out more:

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Who can have hormone therapy?

Hormone therapy is an option for many men with prostate cancer, but it’s used in different ways depending on whether your cancer has spread.

Localised prostate cancer

If your cancer hasn’t spread outside the prostate (localised prostate cancer), you might have hormone therapy alongside your main treatment. Hormone therapy can help shrink the prostate and any cancer inside it, and make the treatment more effective. You might have hormone therapy:

Hormone therapy is not usually given to men having surgery (radical prostatectomy) for localised prostate cancer.

Locally advanced prostate cancer

If your cancer has spread to the area just outside the prostate (locally advanced prostate cancer), you will be offered hormone therapy before, during and after radiotherapy. Hormone therapy can help shrink the prostate and any cancer that has spread, and make the treatment more effective.

You may be offered hormone therapy for up to six months before radiotherapy. And you may continue to have hormone therapy during and after your radiotherapy, for up to three years.

Some men might have hormone therapy on its own if radiotherapy isn’t suitable for them.

Advanced prostate cancer

Hormone therapy will be a life-long treatment for many men with prostate cancer that has spread to other parts of the body (advanced prostate cancer).

Hormone therapy shrinks the cancer and slows down its growth, even if it has spread to other parts of the body. It can’t cure the cancer, but it can keep it under control, sometimes for several years. It can also help manage the symptoms of advanced cancer, such as bone pain.

How long it will control the cancer for varies from man to man. It may depend on how aggressive your cancer is and how far it has spread when you start treatment. It’s difficult for doctors to predict exactly how long it will keep your cancer under control. Speak to your doctor about your own situation.

Prostate cancer that has come back

If your cancer has come back after treatment, hormone therapy will be one of the treatments available for you.

What types of hormone therapy are there?

There are three main ways to have hormone therapy for prostate cancer. These are:

  • injections or implants to stop your testicles making testosterone
  • tablets to block the effects of testosterone
  • surgery to remove the testicles or the parts of the testicles that make testosterone. This is called an orchidectomy.

The type you have will depend on whether your cancer has spread, any other treatments you’re having, and your own personal choice. You may have more than one type of hormone therapy at the same time.

Injections or implants

You may hear this called androgen deprivation therapy (ADT). These work by stopping your brain from telling your body to make testosterone. Injections or implants are as good at controlling prostate cancer as surgery to remove the testicles.

Injections and implants are both given using a needle. Injections are given in a similar way to having a vaccine, where a small amount of liquid is injected under the skin or into the muscle. If you have injections, you will have them in your arm, abdomen (stomach area), thigh or bottom (buttock),depending on which type you’re having. Ask your doctor or nurse whether you will have injections or implants. Implants are given using a larger needle to place a tiny tube under the skin of your arm, which slowly releases the drug.

You will have the injections or implants at your GP surgery or local hospital once a month, once every three months, once every six months, or once a year. How often you have them will depend on the type of hormone therapy.

LHRH agonists

LHRH agonists (luteinizing hormone-releasing hormone agonists) are the most common type of injection or implant. There are several different LHRH agonists, including:

  • goserelin (Zoladex® or Novgos®)
  • leuprorelin acetate (Prostap® or Lutrate®)
  • triptorelin (Decapeptyl® or Gonapeptyl Depot®)
  • buserelin acetate(Suprefact®).

LHRH agonists cause the body to produce more testosterone for a short time after the first injection. This temporary surge in testosterone could cause the cancer to grow more quickly for a short time, which might make any symptoms you have worse – this is known as a flare.

If you’re having an LHRH agonist, you’ll be given a short course of anti-androgen tablets to stop any problems caused by this surge of testosterone. You’ll usually start taking the anti-androgen tablets before having your first injection or implant and continue taking them for a few weeks.

GnRH antagonists

GnRH antagonists (gonadotrophin-releasing hormone antagonists) are used less often than LHRH agonists.You may also hear these called GnRH blockers. At the moment, there is only one type of GnRH antagonist available in the UK, called degarelix (Firmagon®). Degarelix can be used as a first treatment for advanced prostate cancer that has spread to the bones. It may help to prevent metastatic spinal cord compression (MSCC) which can happen if cancer cells grow in or near the spine and press on the spinal cord. 

When you first start this treatment, you will have two injections on the same day – one on each side of your abdomen (stomach area). You will then have a single injection once a month, or switch to an LHRH agonist.

Unlike LHRH agonists, degarelix doesn’t cause a temporary surge in testosterone with the first treatment so you won’t need to take anti-androgen tablets. Instead your testosterone levels will start to drop straight away and symptoms, such as bone pain, should start to improve quickly

Tablets to block the effects of testosterone (anti-androgens)

You may be offered tablets to block testosterone from getting to the cancer cells. These tablets are called anti-androgens. They can be used:

  • on their own
  • before having injections or implants
  • together with injections or implants
  • after surgery to remove the testicles.

Ask your doctor how long you will need to take anti-androgens for, and whether you’re having them with another treatment or on their own.

Anti-androgens taken on their own are less likely to cause sexual problems and bone thinning than other types of hormone therapy. But they may be more likely to cause breast pain and swelling.

If your cancer has spread to other parts of your body (advanced prostate cancer), anti-androgens will be less effective at controlling the cancer than other types of hormone therapy. So if you have advanced prostate cancer, your doctor will usually recommend an LHRH agonist instead.

There are several different anti-androgens, including:

  • bicalutamide (for example Casodex®)
  • flutamide (for example Drogenil®)
  • cyproterone acetate (for example Cyprostat®).

Surgery (orchidectomy)

You may be offered an operation to remove the testicles, or the parts of the testicles that make testosterone. This is called an orchidectomy. It’s not used as often as other types of hormone therapy.

Surgery is very effective at reducing testosterone levels, which should drop to their lowest level very quickly – usually in less than 12 hours. It also means that you won’t need to have regular injections, and there’s no risk that you’ll miss an injection.

Surgery can’t be reversed, so it’s usually only offered to men who need long-term hormone therapy. If you're thinking about having surgery, your doctor may suggest trying injections or implants for a while first to see how you deal with the side effects of low testosterone.

Short-term side effects include swelling and bruising of the scrotum (the skin containing the testicles).

Some men find the thought of having an orchidectomy upsetting, and worry about how they’ll feel once their testicles are removed. Speak to your doctor about any concerns you might have. If you don’t want an orchidectomy, you can usually have a different type of hormone therapy instead.

What are the advantages and disadvantages of hormone therapy?

What may be an advantage for one person might not be for someone else. So speak to your doctor or nurse about your own situation.


  • It can control your cancer, even if it has spread to other parts of your body.
  • It can be used alongside other treatments to make them more effective.
  • It can help to reduce some of the symptoms of advanced prostate cancer, such as urinary symptoms and bone pain.


  • It can cause side effects that might have a big impact on your daily life.
  • Used by itself, hormone therapy can’t cure your cancer, but it can keep it under control, sometimes for several years.

What are the side effects of hormone therapy?

Like all treatments, hormone therapy can cause side effects. These are usually caused by low testosterone levels. You may not get all of the possible side effects. Hormone therapy affects men in different ways. Some men only get a few side effects or don’t get any at all. This doesn’t mean that the treatment isn’t working.

Discuss the possible side effects with your doctor or nurse before you start or change your hormone therapy, or call our Specialist Nurses. If you know what side effects you might get, it can be easier to manage them.

If you have any concerns about your side effects or if you get any new symptoms, such as bone pain, speak to your doctor or nurse, or call our Specialist Nurses.

Side effects of hormone therapy include:

  • hot flushes
  • changes to your sex life including loss of libido and erection problems
  • Extreme tiredness (fatigue)
  • weight gain
  • strength and muscle loss
  • breast swelling and tenderness
  • loss of body hair
  • bone thinning
  • risk of diabetes, heart disease and stroke
  • changes to your mood
  • skin problems.

There are treatments and support to help manage side effects. Some men find that they get better or become easier to deal with over time.

Read more about how hormone therapy can affect you.

How long will side effects last?

Some men find their side effects improve or get easier to manage the longer they’re on hormone therapy. But if side effects don’t improve, there are usually ways to manage them.

Side effects will usually last for as long as you’re on hormone therapy. If you stop using it, the side effects should improve as your testosterone levels start to rise again. This may take several months or years – your side effects won’t stop as soon as you finish your treatment. For some men, the side effects may never go away completely.

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 that treatment as well.

Surgery to remove the testicles (orchidectomy) can’t be reversed, so the side effects will be long-lasting. But there are treatments to help manage them. 

How will I know if my treatment is working?

You will have regular prostate specific antigen (PSA) blood tests to check how well your treatment is working. If your PSA level falls, this usually suggests your treatment is working. How quickly your PSA level falls, and how low, will vary from man to man. Find out more about follow-up after prostate cancer treatment.

A continuous rise in your PSA level may be the first sign that your cancer is no longer responding so well to your hormone therapy. If this happens, your doctor will talk to you about other possible treatment options. You may be offered other types of hormone therapy, a combination of different hormone therapy drugs, or a different type of treatment. Read more about treatment options after your first hormone therapy.

What happens next?

If you have hormone therapy alongside another treatment, speak to your doctor or nurse about how long you will have it for. You will have regular appointments after your finish treatment to check how well it’s working. Read more about follow-up after your treatment finishes.

If you have advanced prostate cancer, hormone therapy is likely to be a life-long treatment.

Intermittent hormone therapy

If you are on life-long hormone therapy and having problems with side effects, you might be able to have intermittent hormone therapy. This involves stopping treatment when your PSA level is low and stable, and starting treatment again if your symptoms get worse or your PSA rises to around 10 or higher.

Some of the side effects, such as hot flushes and sexual problems, may improve while you’re not having treatment. But it can take several months for the side effects to wear off and some men never notice any improvement. Read more about hormone therapy side effects and what can help.

Questions to ask your doctor or nurse

  • What is the aim of treatment?
  • What type of hormone therapy are you recommending for me and why?
  • How will my treatment be monitored?
  • How long will it be before we know if the hormone therapy is working?
  • What are the possible side effects?
  • How long might the side effects last?
  • What will happen if I decide to stop my treatment?
  • Are there any clinical trials that I could take part in?


  • Full list of references  

    • Ahmadi H, Daneshmand S. Androgen deprivation therapy: evidence-based management of side effects: Androgen deprivation therapy. BJU Int. 2013 Apr;111(4):543–8.
    • Ahmadi H, Daneshmand S. Androgen deprivation therapy for prostate cancer: long-term safety and patient outcomes. Patient Relat Outcome Meas. 2014 Jul;63.
    • Ahmed HU, Zacharakis E, Dudderidge T, Armitage JN, Scott R, Calleary J, et al. High-intensity-focused ultrasound in the treatment of primary prostate cancer: the first UK series. Br J Cancer. 2009 Jun 9;101(1):19–26.
    • Alibhai SMH, Gogov S, Allibhai Z. Long-term side effects of androgen deprivation therapy in men with non-metastatic prostate cancer: A systematic literature review. Crit Rev Oncol Hematol. 2006 Dec;60(3):201–15.
    • Azoulay L, Yin H, Benayoun S, Renoux C, Boivin J-F, Suissa S. Androgen-Deprivation Therapy and the Risk of Stroke in Patients With Prostate Cancer. Eur Urol. 2011 Dec;60(6):1244–50.
    • Bolla M, De Reijke TM, Van Tienhoven G, Van den Bergh AC, Oddens J, Poortmans PM, et al. Duration of androgen suppression in the treatment of prostate cancer. N Engl J Med. 2009;360(24):2516–27.
    • Botrel TEA, Clark O, dos Reis RB, Pompeo ACL, Ferreira U, Sadi MV, et al. Intermittent versus continuous androgen deprivation for locally advanced, recurrent or metastatic prostate cancer: a systematic review and meta-analysis. BMC Urol. 2014;14:9.
    • British Uro-oncology Group (BUG), British Association of Urological Surgeons (BAUS). Multi-disciplinary Team (MDT) Guidance for Managing Prostate Cancer. 2013.
    • Cheung AS, Zajac JD, Grossmann M. Muscle and bone effects of androgen deprivation therapy: current and emerging therapies. Endocr Relat Cancer. 2014 Sep 17;21(5):R371–94.
    • Couper JW, Bloch S, Love A, Duchesne G, Macvean M, Kissane DW, et al. The psychosocial impact of prostate cancer on patients and their partners. Med J Aust. 2006;185(8):428.
    • Cramp F, Byron-Daniel J. Exercise for the management of cancer-related fatigue in adults. The Cochrane Collaboration, editor. Cochrane Database Syst Rev [Internet]. 2012 Nov 14; Available from:
    • Eastham JA. Bone health in men receiving androgen deprivation therapy for prostate cancer. J Urol. 2007 Jan;177(1):17–24.
    • Electronic Medicines Compendium. Firmagon 80mg Injection - Summary of Product Characteristics (SPC) - [Internet]. [cited 2015 Oct 27]. Available from:
    • Electronic Medicines Compendium. Prostap 3 DCS - Summary of Product Characteristics (SPC) [cited 2016 Jun 2]. Available from:
    • Elliott S, Latini DM, Walker LM, Wassersug R, Robinson JW. Androgen Deprivation Therapy for Prostate Cancer: Recommendations to Improve Patient and Partner Quality of Life: Improving Life on ADT. J Sex Med. 2010 Sep;7(9):2996–3010.
    • Gardner JR, Livingston PM, Fraser SF. Effects of Exercise on Treatment-Related Adverse Effects for Patients With Prostate Cancer Receiving Androgen-Deprivation Therapy: A Systematic Review. J Clin Oncol. 2014 Feb 1;32(4):335–46.
    • Grossmann M, Hamilton EJ, Gilfillan C, Bolton D, Joon DL, Zajac JD. Bone and metabolic health in patients with non-metastatic prostate cancer who are receiving androgen deprivation therapy. Med J Aust. 2011;194(6):301–6.
    • Gruca D, Bacher P, Tunn U. Safety and tolerability of intermittent androgen deprivation therapy: A literature review: IAD therapy in prostate cancer. Int J Urol. 2012 Jul;19(7):614–25.
    • Haliloglu A, Baltaci S, Yaman O. Penile length changes in men treated with androgen suppression plus radiation therapy for local or locally advanced prostate cancer. J Urol. 2007 Jan;177(1):128–30.
    • Haseen F, Murray LJ, Cardwell CR, O’Sullivan JM, Cantwell MM. The effect of androgen deprivation therapy on body composition in men with prostate cancer: Systematic review and meta-analysis. J Cancer Surviv. 2010 Jun 1;4(2):128–39.
    • Higano CS. Side effects of androgen deprivation therapy: monitoring and minimizing toxicity. Urology. 2003;61(2):32–8.
    • Isbarn H, Pinthus JH, Marks LS, Montorsi F, Morales A, Morgentaler A, et al. Testosterone and Prostate Cancer: Revisiting Old Paradigms. Eur Urol. 2009 Jul;56(1):48–56.
    • Jespersen CG, Nørgaard M, Borre M. Androgen-deprivation Therapy in Treatment of Prostate Cancer and Risk of Myocardial Infarction and Stroke: A Nationwide Danish Population-based Cohort Study. Eur Urol. 2014 Apr;65(4):704–9.
    • Keogh JWL, MacLeod RD. Body Composition, Physical Fitness, Functional Performance, Quality of Life, and Fatigue Benefits of Exercise for Prostate Cancer Patients: A Systematic Review. J Pain Symptom Manage. 2012 Jan;43(1):96–110.
    • Klotz L, Boccon-Gibod L, Shore ND, Andreou C, Persson B-E, Cantor P, et al. The efficacy and safety of degarelix: a 12-month, comparative, randomized, open-label, parallel-group phase III study in patients with prostate cancer. BJU Int. 2008 Dec;102(11):1531–8.
    • Kumar RJ. Adverse events associated with hormonal therapy for prostate cancer. Rev Urol. 2005;7(Suppl 5):S37.
    • Kunath F, Grobe HR, Rücker G, Motschall E, Antes G, Dahm P, et al. Non-steroidal antiandrogen monotherapy compared with luteinising hormone-releasing hormone agonists or surgical castration monotherapy for advanced prostate cancer (review). Cochrane Database Syst Rev. 2014;(6).
    • Loblaw DA, Virgo KS, Nam R, Somerfield MR, Ben-Josef E, Mendelson DS, et al. Initial Hormonal Management of Androgen-Sensitive Metastatic, Recurrent, or Progressive Prostate Cancer: 2007 Update of an American Society of Clinical Oncology Practice Guideline. J Clin Oncol. 2007 Apr 20;25(12):1596–605.
    • Magnan S, Zarychanski R, Pilote L, Bernier L, Shemilt M, Vigneault E, et al. Intermittent vs Continuous Androgen Deprivation Therapy for Prostate Cancer: A Systematic Review and Meta-analysis. JAMA Oncol. 2015 Sep 17;1–10.
    • Mason MD, Parulekar WR, Sydes MR, Brundage M, Kirkbride P, Gospodarowicz M, et al. Final Report of the Intergroup Randomized Study of Combined Androgen-Deprivation Therapy Plus Radiotherapy Versus Androgen-Deprivation Therapy Alone in Locally Advanced Prostate Cancer. J Clin Oncol [Internet]. 2015
    • Mottet N, Bellmunt J, Briers E, Bolla M, Cornford P, De Santis M, et al. Guidelines on prostate cancer. European Association of Urology; 2016.
    • Mottet N, Prayer-Galetti T, Hammerer P, Kattan MW, Tunn U. Optimizing outcomes and quality of life in the hormonal treatment of prostate cancer. BJU Int. 2006 Jul;98(1):20–7.
    • Murphy R, Wassersug R, Dechman G. The role of exercise in managing the adverse effects of androgen deprivation therapy in men with prostate cancer. Phys Ther Rev. 2011 Aug 1;16(4):269–77.
    • National Institute for Health and Care Excellence. Prostate Cancer: diagnosis and treatment. Full guideline 175. 2014.
    • National Institute for Health and Care Excellence. Osteoporosis: fragility fracture. Clinical guideline 146.
    • Parahoo K, McDonough S, McCaughan E, Noyes J, Semple C, Halstead EJ, et al. Psychosocial interventions for men with prostate cancer. In: Cochrane Database of Systematic Reviews [Internet]. John Wiley & Sons, Ltd; 2013
    • Saylor PJ, Smith MR. Metabolic Complications of Androgen Deprivation Therapy for Prostate Cancer. J Urol. 2013 Jan;189(1):S34–44.
    • Schmidt-Hansen M, Hoskin P, Kirkbride P, Hasler E, Bromham N. Hormone and Radiotherapy versus Hormone or Radiotherapy Alone for Non-metastatic Prostate Cancer: A Systematic Review with Meta-analyses. Clin Oncol. 2014 Oct;26(10):e21–46.
    • Schmitt B, Bennett C, Seidenfeld J, Samson D, Wilt T. Maximal androgen blockade for advanced prostate cancer. Cochrane Database Syst Rev [Internet]. 1999 [cited 2014 Oct 13];2. Available from:
    • Schröder F, Crawford ED, Axcrona K, Payne H, Keane TE. Androgen deprivation therapy: past, present and future. BJU Int. 2012 Jun;109 Suppl 6:1–12.
    • Shahinian VB, Kuo Y-F, Freeman JL, Goodwin JS. Risk of the ‘androgen deprivation syndrome’ in men receiving androgen deprivation for prostate cancer. Arch Intern Med. 2006;166(4):465–71.
    • Shore ND, Abrahamsson P-A, Anderson J, Crawford ED, Lange P. New considerations for ADT in advanced prostate cancer and the emerging role of GnRH antagonists. Prostate Cancer Prostatic Dis. 2013;16(1):7–15.
    • Silva FC da, Silva FMC da, Gonçalves F, Santos A, Kliment J, Whelan P, et al. Locally Advanced and Metastatic Prostate Cancer Treated with Intermittent Androgen Monotherapy or Maximal Androgen Blockade: Results from a Randomised Phase 3 Study by the South European Uroncological Group. Eur Urol. 2014 Aug;66(2):232–9.
    • Sountoulides P, Rountos T. Adverse Effects of Androgen Deprivation Therapy for Prostate Cancer: Prevention and Management. ISRN Urol [Internet]. 2013 Jul 25 [cited 2015 Nov 3];2013. Available from:
    • Storey DJ, McLaren DB, Atkinson MA, Butcher I, Frew LC, Smyth JF, et al. Clinically relevant fatigue in men with hormone-sensitive prostate cancer on long-term androgen deprivation therapy. Ann Oncol. 2012;23(6):1542–9.
    • Warde P, Mason M, Ding K, Kirkbride P, Brundage M, Cowan R, et al. Combined androgen deprivation therapy and radiation therapy for locally advanced prostate cancer: a randomised, phase 3 trial. The Lancet. 2011 Dec;378(9809):2104–11.
    • White ID, Wilson J, Aslet P, Baxter AB, Birtle A, Challacombe B, et al. Development of UK guidance on the management of erectile dysfunction resulting from radical radiotherapy and androgen deprivation therapy for prostate cancer. Int J Clin Pract. 2015 Jan;69(1):106–23.
    • Widmark A, Klepp O, Solberg A, Damber J-E, Angelsen A, Fransson P, et al. Endocrine treatment, with or without radiotherapy, in locally advanced prostate cancer (SPCG-7/SFUO-3): an open randomised phase III trial. Lancet. 2009 Jan 24;373(9660):301–8.
    • Zhao J, Zhu S, Sun L, Meng F, Zhao L, Zhao Y, et al. Androgen Deprivation Therapy for Prostate Cancer Is Associated with Cardiovascular Morbidity and Mortality: A Meta-Analysis of Population-Based Observational Studies. Kyprianou N, editor. PLoS ONE. 2014 Sep 29;9(9):e107516.