Preventing Hormone Therapy Side Effects

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A number of interventions are available that can substantially reduce adverse side effects from testosterone inactivating pharmaceuticals (TIP). Side effects vary from patient to patient and are influenced by the different types and duration of TIP usage.​

Loss of Libido

In most cases, libido is an emotional attraction to the opposite sex. Libido is not the same thing as potency, which is defined as the ability to get an erection. TIP causes a low libido about 90% of the time.  Libido returns when TIP is stopped, although some men say libido after TIP is chronically diminished. Loss of libido and the cessation of sexual activity have wide-ranging ramifications far beyond the intended scope of this article. Specialists in sexual counseling are available and can be of great assistance.

Erectile Atrophy

Regardless of whether or not couples continue to have sexual intercourse after treatment, our practice counsels men to induce daily erections to counteract penis shrinkage.  Cialis or Viagra should be taken daily. If a normal pattern of nighttime erections is not restored then either a vacuum pump or injection therapy should be considered.

Muscle Atrophy

Muscle mass must be maintained with a strength training program. Walking, aerobics, and stretching are healthy options but accomplish little toward building muscle mass. Effective strength training requires a program similar to the programs employed by bodybuilders. Ideally, strength training requires participating in one-hour sessions three times a week. The goal is to exercise all major muscle groups: pectorals, deltoids, biceps, triceps, latissimus dorsi, upper and lower back muscles, abdominals, gluteus, quadriceps, hamstrings, and calf muscles. Three sets of 10-12 repetitions should be undertaken with the appropriate weight selected to result in muscle failure toward the end of the third set.

Fatigue and Lassitude

Tiredness and weakness from TIP are a direct result of muscle loss and reversible with strength training. Strength training is very effective for counteracting fatigue. Men who begin strength training when they initiate TIP will not only forestall tiredness, they can actually increase their strength.


TIP causes accelerated osteoporosis, which is a loss of calcium from the bones. Untreated bone loss leads to hip and spine fractures. Osteoporosis can be prevented with medications such as Prolia, Xgeva, Zometa, Boniva, Actonel, and Fosamax, which should be initiated when TIP is started. See the educational booklet titled Osteoporosis.

Hot Flashes

Hot flashes occur in about two-thirds of men on TIP. When severe, Depo-Provera, a progesterone injection, can dramatically reduce hot flashes. Other prescription medications, which are effective about half the time include low dose Effexor, a medication approved for the treatment of depression, and Neurontin, a medication approved to prevent seizures. Transdermal estrogen patches are very effective but sometimes can cause breast enlargement or nipple tenderness.

Weight Gain

TIP slows metabolism causing weight gain. The goal should be to maintain a stable weight by starting a disciplined diet when TIP is being started. It is much easier to prevent weight gain than putting on pounds and then trying to lose it.

Breast Growth

Breast growth (even without estrogen patches) occurs frequently in men treated with Casodex monotherapy and less frequently in men treated with other forms of TIP. If there is any evidence for breast growth or nipple tenderness then therapy with Femara, an estrogen-blocking pill, should be started immediately. Alternatively, a short course of radiation to the nipples can be administered prior to starting TIP.


Blood is a mixture of red cells and "serum" (water). When the proportion of red cell is diminished it is termed anemia. Severe anemia can cause shortness of breath. Milder degrees cause fatigue. Anemia reverses when TIP is stopped. If anemia is severe, it can be corrected with an Aranesp injection. Iron supplements are only beneficial in men with proven iron deficiency.


Joint pain, particularly in the hands, is a common symptom of TIP and often improves with glucosamine, Motrin Aleve or Celebrex.

Liver Changes

Casodex, Flutamide, and Zytiga occasionally cause serious liver problems. Routine blood tests to monitor for liver problems should be done after starting TIP. Liver problems are reversible if the problem is detected in a timely fashion and the medication is stopped.

Mood Swings

Men on TIP occasionally mention increased intensity in their emotions. Some find this effect unpleasant whereas others enjoy it. Low doses of medications such as Zoloft or Paxil can reverse the unpleasant feelings.

Final Thoughts

TIP is a treatment that can be quite tolerable if side effects are expertly managed. Preventative measures such as weight lifting and diet are critically important. Checking blood tests for anemia and liver function is essential. Side effects like joint pains, hot flashes, depression, emotional swings, breast enlargement and impotence can be greatly reduced with judicious measures.

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