Androgen deprivation therapy decreases the amount of circulating androgens, or male hormones, in the body. It is used most often to treat metastatic prostate cancer. The therapy decreases bone pain and increases survival. However, it also produces certain side effects, warranting judicious application of the therapy. In addition, treatment options exist to address and potentially alleviate these side effects.
Sexual and Reproductive Dysfunction
Sexual dysfunction is a common side effect of androgen deprivation. Androgens increase libido, so androgen deprivation therapy can reduce libido. Men may also have trouble achieving and maintaining erections. Penile and testicular size may decrease. In addition, androgens help the body to produce sperm, so sperm production can decrease as well.
Hot Flashes
Hot flashes are a common concern of men undergoing androgen deprivation therapy. Hot flashes consist of a feeling of warmth in the back, upper chest, neck and face that can be associated with sweating and reddening of the skin. Hot flashes occur spontaneously, and they last between a few seconds and an hour. They may be made worse by stress, hot weather, or poor sleep according to a 2005 article in "Reviews in Urology."
Osteoporosis, Bone Fractures and Loss of Muscle
Androgen deprivation therapy also has effects on the musculoskeletal system. It increases bone turnover, which is the breakdown of old bone and creation of new, but favors the breakdown and causes decreases in bone mineral density, which is a marker of osteoporosis. Osteoporosis increases the risk of fractures. The 2005 article in "Reviews in Urology" notes that the therapy probably doubles the risk of fractures. The article also notes that the therapy decreases muscle mass.
Metabolic Changes and Heart Disease
A 2009 article in the "Journal of Urology" notes that androgen deprivation therapy can lead to obesity, insulin resistance and alterations in fat and cholesterol in the blood. These changes may be associated with a greater incidence of diabetes and heart disease. The heart disease stems from coronary arteriosclerosis, which is a narrowing of the arteries of the heart. This can lead to heart attacks and problems with the heart rhythm.
Anemia
Anemia, or low red blood cell counts are commonly encountered in those undergoing androgen deprivation therapy. The 2005 article in "Reviews in Urology" noted that the anemia may be symptomatic in about 10 percent of patients. A common symptom of anemia is fatigue.
Psychological Effects
Androgen deprivation can have emotional effects. These include a short temper, moodiness, crying with minimal provocation, anxiety and depression. Other effects include an impairment of concentration, memory and verbal abilities.
Gynecomastia and Other Symptomos
Another side effect from androgen deprivation therapy is gynecomastia, or the growth of breast tissue. Less frequently reported side effects include the loss of body hair loss, vertigo and dry eyes.
References
- "Physiology"; Linda S. Costanzo; 4th Edition 2009
- "Harrison's Principles of Internal Medicine"; Anthony S. Fauci; 17th Edition 2008
- "Reviews in Urology"; Adverse Events Associated with Hormonal Therapy for Prostate Cancer; Ravi J Kumar; 2005
- "Journal of Urology"; Metabolic complications of androgen deprivation therapy for prostate cancer; Saylor and Smith; May 2009
