What is hormone therapy?

  • Hormone therapy blocks or lowers the amount of testosterone in your body. It can slow down the growth of your prostate cancer. It can also help with some symptoms of advanced prostate cancer, such as bone pain.

 

Watch our short video to learn more about hormone therapy.

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Hormone therapy

Important things to know

What are hormones?

  • Hormones are made by glands. They act like chemical messengers. They travel around the body in your blood.  

What is testosterone?

  • Testosterone is a male sex hormone (an androgen).  It is made mainly by your testicles. A small amount of testosterone is also made by your adrenal glands. These are on top of your kidneys. Testosterone affects:
    • Appearance
    • Sex drive (libido)
    • Sexual function
    • Muscle mass and bone development
    • Weight
    • Growth of body hair
    • Growth and development of male sexual organs at puberty.

       

  • Testosterone usually helps prostate cancer to grow.

What are the benefits of hormone therapy?

  • It can ease symptoms of more advanced prostate cancer, e.g. problems with peeing.
  • You can have it with other treatments such as, radiotherapy. This can make them work better.
  • It can reach the prostate cancer wherever it is in the body.
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Clement
“After a couple of weeks or so I felt I was getting tired. Try and keep active, as much as you can. It’s not easy because you will feel tired but you need to do it as it has an effect of saving your life.”
Clement
Frequently asked questions (FAQs) about hormone therapy injections
  • The pituitary gland is the size of a pea and is found underneath your brain. 
  • It makes luteinising hormone. 
  • This controls the amount of testosterone made by your testicles. 

Luteinising hormone-releasing hormone agonists (LHRH agonists)

  • LHRH agonists stop the pituitary gland from making luteinising hormone. This stops the testicles from making testosterone.
  • Your symptoms can get worse after the first injection (tumour flare). 
Lutenising hormone

 

Examples of hormone injections are:

  • Goserelin (Zoladex) is a small implant given by injection every 28 days or three-monthly
  • Leuprorelin (Prostap) is given monthly or three-monthly
  • Triptorelin (Decapeptyl) is given four-weekly, three-monthly or every 24 weeks. 

 

Gonadotrophin-releasing hormone antagonist (GnRH antagonist)

  • These work in a slightly different way to LHRH agonists. But your testicles will still make less testosterone. 
  • You will not have tumour flare with these injections. 
  • This is mostly for people who have cancer that has spread to their spine. There is only one injection available in the UK. It is called degarelix (Firmagon). 

When is hormone therapy used? 

  • Hormone therapy is used in different ways. This will depend on the stage and the grade of your cancer.

 

Early stage (localised prostate cancer)

  • This is when the cancer is still within the prostate. 
    • You may be offered a course of hormone therapy injections with your radiotherapy. radiotherapy
    • Hormone therapy can help to shrink your prostate and the cancer inside. This can help the radiotherapy to work better.
    • You may have the hormone therapy before, during or after your radiotherapy. Your doctor will decide on how long you need to take the hormone therapy. This can be from three months up to three years. 

 

Locally advanced prostate cancer

  • This is when your cancer has spread just outside your prostate.
  • You may have hormone therapy injections:
    • With your radiotherapy. You may have the hormone therapy before, during or after your radiotherapy.
    • As a treatment on its own. This may happen if you are not able to have radiotherapy or surgery. You may also have regular monitoring.

       

Metastatic prostate cancer

  • You will be given hormone therapy on its own or alongside another treatment, e.g. hormone therapy tablets. hormone therapy tablets
  • This can happen if your cancer has started to grow again while you are on hormone therapy injections. This is called castration-resistant prostate cancer. 
  • Hormone therapy is usually a lifelong treatment at this stage.
  • Testosterone levels in your body rise after the first injection. This could make your symptoms worse. This is called tumour flare. 
  • Your doctor will usually give you a course of hormone tablets. This will protect you from this ‘flare’.  You may start the tablets before your first injection. You usually take the tablets for about three-to-six weeks. 
  • You may have your first injection at the hospital. But often it is done in your GP surgery. All of your follow-up injections will usually be done at your GP surgery.

     

older white man talking with GP
  • If you are having injections, these may cause brief discomfort. 
  • Anyone staying on hormone therapy should have a yearly check-up with their doctor. They will check your:tests
    • Blood pressure
    • Cholesterol
    • Blood sugars – to test for diabetes.
  • They should also talk to you about your bone health and keeping fit.
  • PSA testYou will have regular check-ups with your doctor or specialist nurse.
  • This will include monitoring of your PSA level.
  • This will probably fall while you are on hormone therapy. If it starts to rise again, your doctor will talk to you about other treatment options. 
  • Visit our page about PSA tests for more information (this will open in a new tab).
  • When you are on hormone therapy, you will have your PSA level checked regularly. 
  • If the hormone therapy is working, your PSA level will stay the same or go down. 
  • If your PSA starts to go up, it may mean that your cancer has started to grow again. 
  • When the hormone therapy stops working, this is called castrate -resistant prostate cancer. You may also hear it called hormone- resistant prostate cancer.
  • If this happens, your doctor will talk to you about starting a different treatment or mix of treatments. This may include a different type of hormone therapy. 
  • If you are having hormone therapy injections and become resistant, you will stay on the injections. 
  • Hormone therapy may affect your ability to father a child. It will affect your:
    • Desire for sex
    • Your ability to have an erection
    • Sperm production.
  • It may mean that you will have problems getting someone pregnant. 
  • If you think you may want children, please talk to your doctor before starting treatment. 
  • You may be able to have some of your sperm saved and frozen. This is called sperm banking or sperm cryopreservation. You can learn more about sperm banking on the Human Fertilisation and Embryology Authority website (this link will open in an external tab). 
  • Cancer Research UK also have information about sperm collection and storage (this link will open in an external tab).

image showing sperm being frozen

About this information

  • This information was published in March 2023. We will revise it in March 2024.
  • References and bibliography available on request.
  • If you want to reproduce this content, please see our Reproducing Our Content page (this link will open in a new tab).

What is risk?

  • Risk is the chance something bad could happen when we do something. Even simple things such as walking down the stairs can have risks. But we take risks because we think it will be worth it. We need to think about both the benefits and risks of what might happen when we do something.
  • You should always ask your healthcare team about both the benefits and risks of any treatment.
  • Remember if they tell you about a risk, it doesn‘t mean it will happen to you. They may say one man in ten who has this treatment will have a side effect. But they can‘t tell you if you will be the ‘one’ man who gets this side effect.
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Risk vs Benefit
What are the risks of the different types of hormone therapy (injections)?

Very common side effects

Affects MORE THAN

1 in 10 Risk

Physical

PHYSICAL

  • Hot sweats (flushes)
  • Excessive sweating (hyperhidrosis).
Sexual interest

SEXUAL

  • Decreased sex drive (libido)
  • Problems getting an erection (erectile dysfunction).

Common side effects

Affects UP TO

1 in 10 Risk

Physical

PHYSICAL

  • Weight changes
  • Breast enlargement (gynaecomastia)
  • Impaired glucose tolerance
  • Cardiac failure
  • Heart attack (myocardial infarction)
  • Abnormal blood pressure
  • Bone pain
  • Decreased bone density
  • Tingles, pins and needles (paraesthesia)
  • Spinal cord compression
  • Rash
  • Injection site reaction.
Psychological and Mental

PSYCHOLOGICAL/ MENTAL

  • Mood changes
  • Depression.


Electronic Medicines Compendium (EMC)

  • The EMC contains the most up-to-date, approved and regulated prescribing and patient information for all UK licensed medicines.
  • You can find more information about the side effects of this treatment in the leaflet that comes with your medicine or from the Electronic Medicines Compendium (this link will open in a new tab).
  • You can see the patient information leaflets for Zoladex 3.6mg and for Zoladex 10.8mg (these links will open in new tabs). 

Very common side effects

Affects MORE THAN

1 in 10 Risk

Physical

PHYSICAL

  • Hot sweats (flushes)
  • Excessive sweating (hyperhidrosis)
  • Extreme tiredness (fatigue)
  • Muscle weakness
  • Bone pain
  • Weight fluctuation
  • Shrinking of testicles (testicular atrophy)
  • Injection site reaction (pain, redness, swelling, nodules, abscesses, ulcers and tissue death).
Sexual interest

SEXUAL

  • Decreased sex drive (libido)
  • Problems getting an erection (erectile dysfunction).

Common side effects

Affects UP TO

1 in 10 Risk

Physical

PHYSICAL

  • Decreased appetite
  • Breast enlargement (gynaecomastia)
  • Headache (occasionally severe)
  • Feelong sick (nausea)
  • Inability to sleep (insomnia)
  • Joint pain (arthralgia)
  • Abnormal liver function (usually lasts only a short time).
Psychological and Mental

PSYCHOLOGICAL/ MENTAL

  • Mood changes
  • Depression.

 

Electronic Medicines Compendium (EMC)

Very common side effects

Affects MORE THAN

1 in 10 Risk

Physical

PHYSICAL

  • Hot sweats (flushes)
  • Excessive sweating (hyperhidrosis)
  • Weakness, reduced energy and strength (asthenia)
  • Back pain
  • Burning or prickling sensation in legs (paraesthesia).
Sexual interest

SEXUAL

  • Decreased sex drive (libido)
  • Problems getting an erection and ejaculating (erectile dysfunction).

Common side effects

Affects UP TO

1 in 10 Risk

Physical

PHYSICAL

  • Increased weight
  • Headache
  • Dizziness
  • High blood pressure (hypertension)
  • Dry mouth
  • Feeling sick (nausea)
  • Musculoskeletal pain
  • Pain in extremity
  • Pelvic pain
  • Allergy (hypersensitivity)
  • Injection site reaction (including redness, inflammation and pain)
  • Build-up of fluid in the body (oedema).
Psychological and Mental

PSYCHOLOGICAL/ MENTAL

  • Mood changes
  • Depression.
Sexual interest

SEXUAL

  • Loss of sex drive (libido).

 

Electronic Medicines Compendium (EMC)

  • The EMC contains the most up-to-date, approved and regulated prescribing and patient information for all UK licensed medicines.
  • You can find more information about the side effects of this treatment in the leaflet that comes with your medicine or from the Electronic Medicines Compendium (this link will open in a new external tab).
  • You can see the patient information leaflets for Decapeptyl 3mg, Decapeptyl 11.25mg or Decapeptyl 22.5mg (these links will open in new tabs. Please note that the Decapeptyl 22.5 mg leaflet  is in PDF format so may not be compatible with screen readers).  Listen to the leaflet for Decapeptyl 22.5mg.

Very common side effects

Affects MORE THAN

1 in 10 Risk

Physical

PHYSICAL

  • Hot sweats (flushes)
  • Injection site reaction.

Common side effects

Affects UP TO

1 in 10 Risk

Physical

PHYSICAL

  • Weight increase
  • Breat enlargement (gynaecomastia)
  • Headache
  • Dizziness
  • Problem sleeping (insomnia)
  • Diarrhoea
  • Feeling sick (nausea)
  • Excessive sweating including at night (hyperhidrosis)
  • Rash
  • Pain in the bones, muscles, tendons and joints (musculoskeletal pain and discomfort)
  • Shrinking of the testiclts (testicular atrophy)
  • Chills
  • High temperature (pyrexia)
  • Extreme tiredness (fatigue)
  • Flu like illness
  • Low red blood cell count (anaemia)
  • Increased liver transaminase levels.
Sexual interest

SEXUAL

  • Problems getting an erection (erectile dysfunction).

 

Electronic Medicines Compendium (EMC)

  • The EMC contains the most up-to-date, approved and regulated prescribing and patient information for all UK licensed medicines.
  • You can find more information about the side effects of this treatment in the leaflet that comes with your medicine or from the Electronic Medicines Compendium (this link will open in a new tab).
  • You can see the patient information leaflets for Firmagon 80mg and Firmagon 120mg (these links will open in new tabs. Please note that the leaflets hasve been produced by the drug manufacturer and are in PDF format so may not be compatible with screen readers).  Listen to the Firmagon 80mg leaflet or  Listen to the Firmagon 120mg leaflet
  • The information on the risks comes from very large clinical studies. These typically involved thousands of people being watched over many years. 
  • There may be local data from your area. You can ask your healthcare team if they have this information too. 

About this information

  • This information was published in March 2023. We will revise it in March 2024.
  • References and bibliography available on request.
  • If you want to reproduce this content, please see our Reproducing Our Content page (this link will open in a new tab).

What is the impact?

  • We asked real visitors to the infopool to share their experience of this treatment. They told us how this treatment had impacted their everyday lives in a number of different areas.
  • The numbers and images below represent how many people said this treatment had impacted them ‘a lot’ in each of the different areas.
  • For example, imagine it says ‘25 in 100’ underneath ‘physical and social wellbeing’. This means that 25 out of 100 people who shared their experience of this treatment told us it impacted their ‘physical and social wellbeing’ a lot. However it would also mean that 75 out of 100 people said it had not impacted them a lot.

Physical and social wellbeing

Enjoying activities such as walking or going out to the pub

85 out of 100

Effect on relationships

Ability to make good connections with others

54 out of 100

Sexual activity

Ability to reach sexual arousal, either physically or emotionally

77 out of 100

Sense of self

Knowing who you are and what motivates you

73 out of 100

Wellbeing and quality of life

Feeling good and functioning well in your personal and professional life

77 out of 100

Mental and emotional health

Ability to think clearly, make good decisions, and cope with your emotions

72 out of 100

Fatigue

Feeling of constant physical and/or mental tiredness or weakness

90 out of 100