Hormone Blockade Side Effects
Mark Scholz, MD, Executive Director of The PCRI
Fatigue and Lassitude and Muscle Atrophy
Strength training to build muscles substantially reduces fatigue. This loss can be prevented with a weight training program. Ideally, strength training consists of three, one-hour sessions every week and should include every major muscle group: 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 performed during each one-hour session with weight selected to cause muscle failure toward the end of the third set.
Hormone therapy causes accelerated calcium loss from the bones, termed osteoporosis. Untreated bone loss can result in hip and spine fractures. Osteoporosis can be prevented with medications such as Prolia, Xgeva, Zometa, Boniva, Actonel and Fosamax which should be initiated when hormone therapy is started. Appropriate amounts of calcium, vitamin D and exercise are also required.
Hot flashes occur in about two-thirds of men. When severe, progesterone injections (depo provera) can dramatically reduce in the frequency and intensity of hot flashes. Other medications to be considered are low dose Effexor, a medication approved for the treatment of depression or Neurontin, a medication approved to prevent seizures. Transdermal estrogen patches (Vivelle Dot) are effective over 80% of the time but sometimes cause breast enlargement or nipple tenderness.
Breast growth (even without estrogen patches) occurs frequently in men treated with Casodex monotherapy and less frequently, about a third of the time, in men treated with other forms of TIP. If there is early evidence of breast growth, an estrogen blocking pill called Femara should be started immediately. Alternatively, a short course of radiation to the nipples can be administered prior to starting TIP.
While on hormonal therapy the occurrence of erections while sleeping is usually halted, potentially resulting in permanent shrinkage of the penis. The normal pattern of nocturnal erections can usually be reestablished with the regular use of Cialis or Viagra. If these medications fail to restore the normal pattern of nighttime erections then either a vacuum pump or injection therapy should be considered.
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 the hormone therapy is stopped. If anemia is severe it can be corrected with a medications such as Procrit and Aranesp. Iron is not beneficial.
Casodex, Flutamide, Nilutamide and Zytiga occasionally cause serious liver problems. This is detected by blood tests that need to be done routinely after starting treatment. The problem is easily reversible if detected early and the medication is stopped in a timely fashion.
Mood Swings and Depression
Men on TIP occasionally experience more intense feelings or depressive feelings. Low doses of medications such as Zoloft, Celexa or Paxil can effectively reverse these unpleasant feelings.
Other Side Effects
Nilutamide can occasionally cause lung problems. Treatment needs to be stopped immediately if shortness of breath or a new cough occurs. Xtandi rarely causes seizures so men need to be advised about the risks loss of consciousness while operating heavy equipment. Since Zytiga can lower potassium levels, blood levels need to be monitored.