How does hormone therapy work?
Hormone therapy works by either stopping your body from making testosterone, or by stopping testosterone from reaching the cancer cells.
Prostate cancer cells usually need testosterone to grow. Testosterone is a hormone that controls how the prostate grows and develops. It also controls other male characteristics, such as muscle strength, erections, and the size and function 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, the cancer will usually shrink, even if it has spread to other parts of your body.
Hormone therapy on its own 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 the treatment more effective.
Watch our video about hormone therapy to find out more:
Who can have hormone therapy?
Hormone therapy is an option for many people with prostate cancer, but it’s used in different ways depending on whether your cancer has spread.
Localised (early) 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 shrink the prostate and any cancer inside it, which makes the cancer easier to treat. It can also make your main treatment more effective. You might have hormone therapy:
- for six months before, during or after external beam radiotherapy
- for up to three years after external beam radiotherapy, if there is a risk of your cancer spreading outside the prostate
- for a few months before starting permanent seed brachytherapy, and before and after high dose-rate brachytherapy – both are types of internal radiotherapy
- before having high-intensity focused ultrasound (HIFU).
Hormone therapy is not usually given to men having surgery to remove their prostate (radical prostatectomy).
Read more about localised prostate cancer.
Locally advanced prostate cancer
If your cancer has spread to the area just outside the prostate (locally advanced prostate cancer), you may have 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.
Read more about locally advanced prostate cancer.
Advanced (metastatic) prostate cancer
Hormone therapy will be a life-long treatment for most men with prostate cancer that has spread to other parts of the body (advanced or metastatic prostate cancer).
Hormone therapy shrinks the cancer and slows down its growth, wherever it has spread to in the body. It can’t cure the cancer, but it can keep it under control, often for years. It can also help manage 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. It’s difficult for doctors to know exactly how long it will keep your cancer under control. Speak to your doctor or nurse about your own situation.
Read more about advanced prostate cancer.
Prostate cancer that has come back after treatment (recurrent prostate cancer)
If your cancer has come back after treatment for localised or locally advanced prostate cancer, hormone therapy will be one of the treatments available to you.
Read more about recurrent prostate cancer.
Unsure about your diagnosis and treatment options?
If you have any questions about your diagnosis at any time, ask your doctor or nurse. They can explain your test results and your treatment options. Make sure you have all the information you need. Read more about how prostate cancer is diagnosed.
Hormone therapy has kept my prostate cancer under control for seven years.
What types of hormone therapy are there?
There are three main ways to have hormone therapy for prostate cancer. These are:
- injections or implants
- surgery to remove the testicles (orchidectomy).
The type of hormone therapy 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
These stop your body from making testosterone. They work by blocking the message from the brain that tells your testicles to make testosterone. Injections or implants are as good at controlling prostate cancer as surgery to remove the testicles.
Ask your doctor or nurse whether you will have injections or implants. They are both given using a needle.
Injections use a needle to inject a small amount of liquid under the skin or into muscle. They may be given in your arm, abdomen (stomach area), thigh or bottom (buttock), depending on the type you’re having.
Implants may be given as a small pellet that is placed under the skin in the abdomen and slowly releases the drug.
You will have the injections or implants at your GP surgery or local hospital. How often you have them will vary, depending on the type you are having. Some men have an injection or implant once a month, while others have an injection every three or six months.
LHRH agonists (luteinizing hormone-releasing hormone agonists) are the most common type of injection or implant. There are several available that all work in the same way, including:
- goserelin (Zoladex®)
- 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 usually happens about two or three days after you have 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 for about a week – this is known as a flare.
If you’re having an LHRH agonist, you’ll be given a short course of anti-androgen tablets as well. This should stop any problems caused by this surge of testosterone.
You’ll usually start taking the anti-androgen tablets before your first injection or implant and keep taking them for a few weeks.
GnRH antagonists (gonadotrophin-releasing hormone antagonists) are used less often than LHRH agonists. You may also hear them called GnRH blockers.
There’s one type 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 start degarelix, you’ll have two injections on the same day – one on each side of your abdomen (stomach area). You will then have one injection every month, or some men switch to an LHRH agonist after discussing this with their doctor.
Unlike LHRH agonists, degarelix doesn’t cause a 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, usually on the first day of having treatment. Symptoms such as bone pain should start to improve quickly.
Keeping track of your injections
If you’re having injections, it’s a good idea to record all the dates so that you don’t miss an appointment. There’s space to record details in our booklet, Living with hormone therapy: A guide for men with prostate cancer.
If your injection is a few days late, it shouldn’t be a problem. But if your injection is late by a couple of weeks or more, your body may start to produce more testosterone, which may cause the cancer to start growing again.
If you think you’ve missed an injection, tell your doctor or nurse as soon as possible.
Anti-androgen tablets stop testosterone from reaching the cancer cells. They can be used:
- on their own
- before having injections or implants
- together with injections or implants
- after surgery to remove the testicles (orchidectomy).
There are different types of anti-androgen tablets, including:
- bicalutamide (Casodex®)
- cyproterone acetate (Cyprostat®)
- flutamide (Drogenil®).
Ask your doctor how long you’ll 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 swelling and tenderness.
If your cancer is advanced, anti-androgens will be less effective than other types of hormone therapy. So if you have advanced cancer, your doctor will usually recommend an LHRH agonist.
New (second-generation) hormone therapy
There are newer types of hormone therapy that can be used to treat some men with prostate cancer. You may hear them called new or second-generation hormone therapy. They may be used in combination with first line hormone therapy treatment, or when your prostate cancer has stopped responding other types of hormone therapy. They include abiraterone (Zytiga®), enzalutamide (Xtandi®), apalutamide (Erleada®) and darolutamide (Nubeqa®).
Abiraterone (Zytiga®) tablets are most commonly given to men with advanced prostate cancer that’s stopped responding to standard hormone therapy. But some hospitals now offer abiraterone as a first treatment for advanced prostate cancer, for example if a man isn’t fit enough for chemotherapy. Find out more about abiraterone.
Enzalutamide (Xtandi®) tablets may be offered to men with advanced prostate cancer as a first treatment in combination with other treatments, or if your cancer has stopped responding to other types of hormone therapy. Find out more about enzalutamide.
Darolutamide (Nubeqa®) is a new type of hormone therapy. It won’t cure your prostate cancer, but it can help keep it under control. It has also been shown to give some men longer before their cancer spreads to other parts of the body (advanced prostate cancer). Find out more about darolutamide.
Apalutamide (Erleada®) tablets may be offered to some men with localised prostate cancer or locally advanced prostate cancer that has stopped responding to other types of hormone therapy, but has not yet spread to other parts of the body (advanced prostate cancer). Find out more about apalutamide.
You may be offered an operation to remove the testicles, or the parts of the testicles that make testosterone. This is called an orchidectomy (or orchiectomy). 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, so 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. This will give you and your doctor a chance to see how you deal with the side effects of low testosterone.
Short-term side effects of an orchidectomy 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 if you have any concerns.
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 important to one person might be less important to someone else. So speak to your doctor or nurse about your own situation.
- It’s an effective way to control prostate 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.
- It can’t cure your cancer when it’s used by itself, but it can help to keep the cancer under control, sometimes for many 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.
Hormone therapy affects men in different ways and you may not get all of the possible side effects. 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.
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.
Your side effects won’t stop straight away – it may take several months or years. 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 permanent. But there are treatments to help manage them.
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 get any new symptoms, such as bone pain, speak to your doctor or nurse, or call our Specialist Nurses.
We describe the most common side effects of hormone therapy below. Find out more about side effects of hormone therapy and how you can manage them.
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.
Some men find that their hot flushes get milder and happen less often over time, but other men continue to have hot flushes for as long as they have hormone therapy.
There are things that can help manage hot flushes, including lifestyle changes and medicines. Speak to your doctor if you get hot flushes.
Some men also use complementary therapies to manage hot flushes, such as acupuncture, cognitive behavioural therapy (CBT) and herbal remedies. But there isn’t any strong evidence that these work.
If you’re thinking about using any complementary therapies, make sure you tell your doctor or nurse as they might interfere with your cancer treatment. You should also tell your complementary therapist about any cancer treatments you’re having.
I have hot flushes through the night. I used to be angry but now I use the cooling off time to stretch and plan the next day.
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 affect your energy levels, motivation and emotions.
This may improve over time and there are things you can do to help manage fatigue.
These include being physically active and planning your day to make the most of when you have more energy. Read more about fatigue and prostate cancer.
Our Specialist Nurses can talk to you in depth about your experience of fatigue, and the impact it’s having on your day-to-day life. They can help you make positive changes to your behaviour and lifestyle, which can improve your fatigue over time.
Changes to your sex life
Hormone therapy can cause the following changes to your sex life:
- less desire for sex (low libido)
- problems getting or keeping an erection (erectile dysfunction)
- producing less semen and having less intense orgasms
- changes to the size of your penis and the size or shape of your testicles.
There are treatments and ways to manage changes to your sex life. Hormone therapy reduces your desire for sex. So treatments that only work when you have desire, such as tablets, are unlikely to work.
But injections, pellets, cream or a vacuum pump may still help you get an erection, even if your desire for sex is low.
Read more about prostate cancer and your sex life.
Some people put on weight while they’re on hormone therapy, particularly around the waist. Some men find this hard to deal with, especially if they’ve never had problems with their weight in the past.
Physical activity and a healthy diet can help you stay a healthy weight. Read more about diet and physical activity.
Strength and muscle loss
Testosterone plays an important part in the physical make up of men’s bodies. Hormone therapy can cause you to lose some muscle tissue. This can change the way your body looks and how physically strong you feel.
Regular gentle resistance exercise, such as lifting light weights or using elastic resistance bands, may help to prevent muscle loss and keep your muscles strong. Read more about diet and physical activity for men with prostate cancer.
Some men may also get aching muscles 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.
Memory and concentration
If you’re having hormone therapy you may find it difficult to concentrate or focus on certain tasks. Or you might struggle to remember things as well as you used to.
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 or ability to concentrate.
Memory problems 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.
Breast swelling or 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.
Breast swelling is more common in men who are taking anti-androgen on their own.
If you put on weight while you’re on hormone therapy, this can also lead to larger breasts.
There are ways to reduce your risk of breast swelling and tenderness, or help treat it. These include treating the breast area with a single dose of radiotherapy during your first six months on hormone therapy, taking tablets (such as tamoxifen), or sometimes having surgery to remove some of the breast tissue.
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. This can happen anywhere on your body, including your face, chest and pubic area. The hair should grow back if you stop hormone therapy.
Testosterone helps to keep bones strong. Long-term hormone therapy can make your bones weaker and cause a condition called osteoporosis. This means you may be more likely to have broken bones (fractures).
Anti-androgens are less likely to cause bone thinning than other types of hormone therapy.
Your doctor may suggest you have a type of X-ray called a bone density or DEXA (dual energy X-ray absorptiometry) scan before you start hormone therapy. This will show any areas of weak bone.
You might also have a bone density scan after you’ve been on hormone therapy for a few years. This will check for any signs of bone thinning.
Lifestyle changes such as being more active and changes to your diet may help reduce your risk of bone thinning.
We don’t yet know whether exercise can help to prevent bone thinning in men who are on hormone therapy. But regular physical activity could help to keep you strong and prevent falls that could cause broken bones.
These types of exercise may be particularly helpful:
- gentle resistance exercise, such as lifting light weights or using elastic resistance bands
- weight-bearing exercise, where you’re standing up and have to support your own weight, such as walking, climbing stairs, tennis and dancing.
Risk of other health problems
Hormone therapy may slightly increase your chance of developing other health problems, including:
- heart disease
- type-2 diabetes
- blood clots.
Before you start hormone therapy, tell your doctor if you’ve ever had any of the problems listed above, or if you’re taking medicines to treat another health problem, such as high blood pressure (hypertension) or high levels of cholesterol (hypercholesterolaemia).
You can reduce your risk of many health problems by making lifestyle changes, such as eating a well-balanced diet, drinking less alcohol, being physically active and stopping smoking.
Read more about diet and physical activity for men with prostate cancer.
Changes to your mood
Hormone therapy can affect your mood. You may feel more emotional than usual or just ‘different’ to how you felt before. Some men find that they cry a lot. You may also get mood swings, such as feeling tearful then angry.
Just knowing that hormone therapy might be causing these feelings can help.
Some men experience low moods, anxiety or depression. This could be caused by the hormone therapy itself, or by dealing with your prostate cancer diagnosis. It could also be due to the impact that treatment is having on your life.
If your mood is often very low, you are losing interest in things, or your sleep pattern or appetite has changed a lot, speak to your doctor or nurse. These can be signs of depression, but there are things that can help.
If you are on degarelix, the skin around the area where you have the injections may feel red, hard, swollen and sore. This usually settles down after a few days and is often worse after the first injection than the later ones. Mild pain-relieving medicines, such as paracetamol, or using a cool pack on the area can help.
How will I know if my treatment is working?
You will have regular appointments to check how well your treatment is working and monitor any side effects. These will involve regular prostate specific antigen (PSA) blood tests to measure the amount of PSA in your blood.
PSA is a protein produced by cells in your prostate and also by prostate cancer cells, even if they have spread to other parts of your body. The PSA test is a good way to check how well your treatment is working.
How your treatment is monitored will depend on whether you’re having hormone therapy as part of treatment that aims to cure your prostate cancer, or having life-long hormone therapy to keep advanced prostate cancer under control.
You can contact your nurse at the hospital, or our Specialist Nurses, between appointments if you have any side effects or symptoms that you’d like to talk about.
What happens next?
If you’re having treatment that aims to cure your prostate cancer
If your PSA level falls and stays low, this usually suggests your treatment is working. How quickly your PSA level falls, and how low, will depend on the type of treatment you’ve had and will be different for everyone. Read more about follow-up after prostate cancer treatment.
At some hospitals, you may have fewer hospital appointments, and be encouraged to take greater control of your own health and wellbeing. You might hear this called self-management. Instead of going to the hospital, you may talk to your doctor or nurse over the telephone.
Men often prefer this type of follow-up, as it means you can avoid going to hospital appointments when you’re feeling well and don’t have any concerns. You, or your doctor or nurse, can arrange an appointment at any point if you have any questions or concerns.
Speak to your doctor or nurse about how long you will have hormone therapy for. After you stop having hormone therapy, you’ll continue to have regular follow-up appointments, including PSA tests.
If you’ve had radiotherapy, your PSA level may rise a little when you stop hormone therapy. If it continues to rise, this could mean that your prostate cancer has come back.
Your doctor might suggest that you have some scans to see if anything has changed. They will then be able to talk to you about further treatments, if you need them. Read more about recurrent prostate cancer.
If you’re having life-long hormone therapy for advanced prostate cancer
If you have advanced prostate cancer, it’s likely that you’ll have hormone therapy as a life-long treatment.
As well as regular PSA tests, your doctor will check for any changes in symptoms such as pain or weight loss. You may also have regular scans to keep an eye on your cancer.
If your PSA level starts to rise or your scans show changes, this may be the first sign that your hormone therapy is no longer working so well. 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 other treatment options after you first hormone therapy.
Intermittent hormone therapy
If you’re on life-long hormone therapy and are finding the side effects difficult to manage, 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 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 side effects to improve, and some men never notice any improvement. Read more about living with hormone therapy.
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 often will I have my injections or implants?
- 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, and how long will they last?
- What will happen if I decide to stop my treatment?
- Are there any clinical trials that I could take part in?
Updated: November 2022 | Due for Review: February 2024
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