Key facts
- One sentence explains the whole treatment. Most prostate cancer is driven by testosterone, so the treatment removes or blocks it, and every effect follows from that.
- This is not an enlarged prostate, which is a different condition treated with different medicines.
- Hot flushes are the commonest complaint and are worse in this climate, which is a legitimate thing to raise rather than endure.
- Bone thinning is the silent effect, felt by nobody and therefore monitored rather than noticed.
- The sexual effects are the usual reason men stop quietly, and stopping without telling anyone is the worst available option.
- Abiraterone is a closely supervised treatment given alongside a steroid, with regular monitoring.
- Nothing here is a reason to change anything. It is background for the conversation with your urologist or oncologist.
The diagnosis was managed. The scans, the waiting, the appointments where you took notes, the conversations with family, all of it handled with a competence that surprised you.
And then some months later you are standing in a lift, soaked through, for the fourth time that day, and it is this, the least serious thing on the list, that is making you consider giving up.
That is a common story, and the reason it is worth writing about is that the giving up usually happens without anyone being told.
What the treatment is doing
Most prostate cancer cells grow in response to testosterone. So the treatment reduces testosterone or blocks its effect on the cancer, either by injections that switch off production, by tablets that block the receptor, by medicines that stop the body making the hormone at all, or by surgery.
Everything else in this article follows from that one fact. The effects people find hardest are not random side effects; they are what happens to a male body when testosterone is deliberately taken out of it. Knowing that helps, because it makes the effects predictable rather than mysterious, and it explains why they are the price of the mechanism rather than a sign something is going wrong.
The National Cancer Centre Singapore sets out prostate cancer and its treatments.
The tablets we list are bicalutamide and flutamide, which block the receptor, and abiraterone, which reduces the body’s production of androgens more completely and is used in more advanced disease. Abiraterone is always given alongside a steroid and with regular blood monitoring, which is why it is a closely supervised treatment rather than an ordinary prescription. See oncology support and prostate cancer.
A clarification worth making early, because the search terms overlap heavily: this is not the same as treatment for an enlarged prostate. That is a separate, non-cancerous condition, covered in enlarged prostate and the night you blame on the beer, and it uses different medicines entirely.
What actually happens, honestly
| Effect | What it is like | What can be done |
|---|---|---|
| Hot flushes | The commonest complaint, and often the most disruptive day to day | Several approaches exist; worth raising rather than enduring |
| Fatigue | Not ordinary tiredness; a flatness that sleep does not fix | Activity helps more than rest, counterintuitively |
| Loss of libido and erectile function | Near universal on full treatment, and rarely discussed properly | Depends on the treatment and its duration; ask |
| Mood changes | Low mood, irritability, tearfulness that men often do not connect to the treatment | Recognised and treatable, not a character failure |
| Breast tenderness or growth | More common with the receptor blockers | Preventable and treatable in some situations if raised early |
| Bone thinning | Silent, no symptoms at all | Monitored, and managed when it appears |
| Muscle loss and weight gain | Gradual, and easy to attribute to age | Resistance exercise genuinely helps |
Two of those deserve more than a row.
The one nobody starts
The sexual effects are the most common reason men stop hormone therapy without telling anybody.
That sentence is the point of this article. A man is handed a treatment for a serious cancer, experiences something that feels both personal and trivial next to the diagnosis, decides he cannot reasonably complain about it, and quietly stops or becomes unreliable about taking it. The oncology team finds out at the next appointment, or later, or not at all.
It is worth saying clearly that this is not a trivial complaint and is not treated as one by anyone competent. Sexual function, mood and identity are part of what treatment is meant to protect, not an indulgence to be traded away silently. There are genuine differences between treatments in how much they affect this, there are situations where an approach can be modified, and there are things that help with parts of it.
None of which is available to somebody who has not said anything.
The same goes for mood. Men on androgen deprivation frequently describe low mood, tearfulness and a shortening temper, and frequently do not connect any of it to the medicine. It is a recognised effect, and it can be addressed.
The silent one
Removing testosterone accelerates bone loss, and bone loss produces no symptoms whatsoever until something breaks.
So it is monitored rather than noticed, on a schedule your team sets, with attention to calcium and vitamin D, weight-bearing and resistance exercise, and specific bone treatment when it is warranted. If you have read our article on glaucoma drops, the logic will be familiar: the conditions that give you nothing to feel are the ones where the appointment does the work your body cannot.
Exercise deserves emphasis here because it addresses several of these at once, bone, muscle, fatigue and mood, and because it is the part people abandon exactly when it would help most.
Hot flushes, here
A specific regional note that is not in most articles.
Hot flushes are unpleasant anywhere. In a climate where you are already at the edge of comfortable, they are considerably worse, and they interact with everything in blood pressure medicine in a hot climate if you also take something for that.
That is a legitimate thing to raise with your team rather than something to be stoical about. It changes daily life, it affects sleep, and sleep affects everything else. Practical things help at the margin, breathable clothing, a cooler bedroom, identifying triggers. So do medical approaches, and they are worth asking about.
Also worth reading
For the non-cancerous prostate condition, see enlarged prostate and the night you blame on the beer. For the equivalent treatment in breast cancer, see hormone therapy for breast cancer. For keeping a long treatment supplied across borders, see buying generic medicines in Asia.
FAQ
Will the effects reverse if treatment stops?
It depends on the treatment, how long it ran and your age, and some effects recover while others recover partly. Whether stopping is even appropriate is entirely a clinical decision, so this is a question for your team rather than a plan.
Is hormone therapy chemotherapy?
No. They are different treatments with different mechanisms and very different side effects, though some men receive both at different stages.
Can I do anything about the fatigue?
Regular activity, including resistance exercise, has better evidence than rest, which is the opposite of what fatigue makes you want to do. Start where you are rather than where you used to be.
Should I take testosterone to feel better?
No. Testosterone is the thing the treatment is removing, and taking it would work directly against the purpose of the treatment. If you have been offered it by anyone outside your cancer team, tell your cancer team.
Do I need to stop drinking coffee or change my diet?
There is no single diet that changes this. What does matter, for bone, muscle and mood, is adequate protein, calcium and vitamin D and staying active, and your team can be specific about your situation.
Sources
- National Cancer Centre Singapore, prostate cancer
- SingHealth, benign prostatic hyperplasia (for the distinction from the non-cancerous condition)
This article is general information, checked on 10 August 2026. It contains no doses, no schedules and no treatment protocols, and it is not a substitute for the team managing your care.
