Managing hormonal symptoms

Hormonal therapy can cause side effects, sometimes called hormonal symptoms. Talk to your doctor before your treatment starts so you understand which symptoms may affect you. There are different things that can help manage them.

Common hormonal symptoms include:

  • Sexual effects – you may no longer be able to have an erection: there are many ways to help this.
  • Hot flushes – these can be mild or severe.
  • Difficulty sleeping – anxiety or hot flushes may cause you to sleep less.
  • Tiredness.
  • Mood changes.
  • Breast swelling or tenderness.

The following side effects may occur in men who have hormonal therapy for six months or more:

  • Weight gain and loss of muscle strength.
  • Bone thinning (osteoporosis).
  • Risk of heart disease and diabetes.

If you are having long term hormonal therapy, it may be possible to have the treatment for a few months and then stop for a time. This is known as intermittent therapy and can help reduce the risk of side effects.

Managing hormonal symptoms

There are many ways to manage side effects of hormonal therapies. Your cancer specialist and specialist nurse can give you more information and advice for your situation.

Sexual effects

Hormonal therapies can reduce sex drive. They may also cause difficulty in having an erection. This is called erectile dysfunction or ED. Any sexual effects usually continue for as long as the treatment is given.

If treatment is stopped, sexual problems may improve. However, some men find that problems carry on after treatment is over. ED is usually permanent when men have both testicles removed.

If you have problems getting or keeping an erection, there are treatments that may help. However, they don't work for everyone and won't increase your desire to have sex (libido).

Tablets such as sildenafil (Viagra®), vardenafil (Levitra®) and tadalafil (Cialis®) can help produce an erection by increasing the flow of blood to the penis. These tablets can be prescribed by your doctor. They may not be recommended for you if you have heart problems and/or are taking certain drugs, such as nitrates.

It's possible to buy these types of tablets on the internet, but this is not recommended. It can be unsafe to take them without first seeing a doctor who can check that they are suitable for you. It can also be difficult to know if drugs bought online are the correct drugs and not substitutes that look the same.

You may be able to buy Viagra® tablets from certain high street stores or chemists that have specially trained pharmacists. Before they can give you Viagra®, you will need to have a health check and fill out a health questionnaire.

Sometimes a pellet can be inserted into the penis, or drugs injected into it (with a small needle), to help give an erection. These can be prescribed by your GP.

Vacuum pumps draw blood into the penis, helping to produce an erection. A ring is then placed around the base of the penis, trapping the blood, to help maintain an erection.

Many men find it difficult to talk about sexual issues because they feel embarrassed. But your doctor or nurse will be used to talking about this kind of thing, and can give you information and support. If you need additional support, they can also refer you to erectile dysfunction services and/or for specialist counselling.

Coping with sexual difficulties

Brian talks about the impact of prostate cancer and impotence on his sex life. He explains how his relationship with Elizabeth remained strong.

About our cancer information videos

Coping with sexual difficulties

Brian talks about the impact of prostate cancer and impotence on his sex life. He explains how his relationship with Elizabeth remained strong.

About our cancer information videos

Hot flushes

These are a common side effect of hormonal therapy for prostate cancer. They can be mild or more severe.

During a hot flush, you feel warmth in your neck and face and your skin may redden. Mild flushes last for a few seconds up to about a couple of minutes. More severe flushes can last for 10 minutes or more. You may feel anxious or irritable during a hot flush.

Hot flushes and sweats may reduce as your body adjusts to hormonal treatment. They usually stop completely a few months after treatment finishes.

In certain situations for some men, drinks or foods may bring on a flush or sweat. Try to keep a note of things that trigger flushes so that you can avoid them.

Here are some tips:

  • Wear layers of light clothing, preferably cotton, which you can easily take off or put back on depending on your body temperature.
  • Cut down on alcohol, nicotine and hot drinks containing caffeine, particularly coffee and tea.
  • Lukewarm baths and showers are less likely to trigger sweats than hot ones.
  • Hot flushes and sweats are often worse at night. Put a soft cotton towel on your bed that you can easily change if it gets wet during the night. Use light bedclothes and cotton clothing to help you feel cooler at night.

If hot flushes are troublesome, your cancer specialist may prescribe a drug to reduce them. The most commonly used is a tablet called medroxyprogesterone. Other drugs that may be prescribed to reduce hot flushes include cyproterone acetate (Cyprostat®) and megestrol acetate (Megace®). Your doctor can give you further advice.

Difficulty sleeping (insomnia)

You may have difficulty sleeping due to hot flushes, sweats or anxiety.

Here are some tips you may want to try:

  • A warm herbal or milk drink before bed can help you relax.
  • Using relaxation CDs, relaxation exercises, visualisation, meditation or massage can help reduce anxiety and sleeplessness.
  • If you can't sleep get up and read, listen to the radio or an audiobook, or watch TV until you feel sleepy.
  • Your GP can prescribe sleeping tablets for a short period of time to help you get back to a better sleeping pattern.

We have more information on difficulty sleeping.

Tiredness (fatigue)

Hormonal treatment can make you feel mentally and physically tired. It can help to plan rest periods into your day so that you have more energy to do the things you want. If you feel very tired, you may need help with tasks that you find too demanding. 

Research has shown that aerobic exercises (like brisk walking) and muscle strengthening exercises (such as lifting weights) done at least twice weekly can reduce tiredness in men on hormonal therapy. This type of exercise won’t be right for everyone so it’s important to get medical advice before starting. Ask your doctor or nurse what is safe for you to do. 

If tiredness makes you feel sleepy, don’t drive or operate machinery.

Mood changes

You may experience mood changes and feel anxious or low without knowing why. This can be a side effect of hormonal therapy. It can also be due to dealing with the emotional and physical effects of prostate cancer and its treatment.

Tell your cancer specialist, family doctor or nurse specialist if you experience mood changes. They can support you and, if appropriate, prescribe drugs to help or refer you to a counsellor

You may find it helpful to talk about your feelings to family and friends so they understand how you feel and support you. 

Breast swelling or tenderness

Some drugs may cause breast swelling and tenderness. This is called gynaecomastia. If you do have breast tenderness, your doctor can prescribe medicines to reduce any discomfort. 

You may be offered a low dose of radiation to the breast tissue before or soon after the start of treatment if you are having bicalutamide or flutamide for six months or more. This is to help prevent gynaecomastia. 

Sometimes doctors prescribe a tablet called tamoxifen to reduce breast swelling and tenderness. 

Weight gain and loss of muscle strength

Taking hormonal therapy for six months or more can cause weight gain, particularly around your waist. You may also notice a reduction in muscle mass and strength. 

Exercise can help keep your weight stable. Even regular short walks can help. It's also important to eat a healthy balanced diet. Your doctor or nurse can give you further advice about managing weight gain or refer you to a dietitian. 

Doing regular resistance training, such as lifting weights, may help you to reduce loss of muscle strength. Ask your doctor or nurse for advice before starting any exercise programme.

Bone thinning (osteoporosis)

Having both testicles removed, or being on long-term treatment with a GnRH analogue increases your risk of developing osteoporosis. 

Cutting down on caffeine, sticking to sensible drinking guidelines for alcohol and not smoking will help lower your risk. 

Regular weight-bearing exercises such as walking, dancing, hiking or gentle weight-lifting can help keep your bones healthy. Swimming and cycling are less helpful, as your bones aren't supporting your weight. 

It's important to make sure that you get enough calcium and vitamin D (which helps your body use calcium effectively) in your diet. Dairy products are a good source of calcium. You also get calcium from eggs, green leafy vegetables, nuts and fish such as whitebait, sardines and pilchards. 

Let your doctor know if you have discomfort in your joints or bones. If you have osteoporosis your doctor may prescribe drugs called bisphosphonates. They help to strengthen bones. Your doctor can give you more information about them. 

Risk of heart disease and diabetes

There may be an increased risk of developing heart disease or diabetes when taking some hormone therapies for six months or more. The benefits of hormonal treatment generally outweigh the possible risks. Your specialist can talk to you about the possible risks and benefits in your situation. Eating a healthy dietnot smoking, staying within the recommended limits for alcohol, keeping to a healthy weight and being physically active can reduce your risk.

Intermittent hormonal therapy

To reduce the risk of side effects in men having long term hormone therapy, it may be possible to have breaks from treatment. Hormonal therapy is given for a few months until the cancer is at a very low level which is measured by a blood test (PSA test). The treatment is then stopped, giving you a break from hormonal treatment and its side effects. During this break, you have your PSA checked every three months. Hormonal treatment is restarted when PSA levels rise above a certain level.  

If intermittent therapy might be suitable for you, your cancer specialist will talk through the possible benefits and disadvantages with you before you decide.

Useful organisations

National Osteoporosis Society

The National Osteoporosis Society is an independent charity which offers advice and information to the general public and health care professionals. Provides support for people with osteoporosis via its helpline, resources and a network of local groups.

Prostate Cancer Charity

Prostate Cancer UK offers support and information to anyone affected by prostate cancer. The helpline is staffed by experienced nurses. Also funds research and can put men in touch with others affected by prostate cancer.