Staying healthy when on ADT hormone therapy

Prostate cancer is a very treatable cancer but the male sex hormone, testosterone, an androgen, can fuel the growth of prostate cancer cells, accelerating the disease. To reduce the amount of testosterone a man’s body produces helping slow cancer’s growth, some men may require a hormone therapy called androgen deprivation therapy (ADT), helping improve survival rates. However, ADT treatment can have long-lasting side effects, diminishing a man’s quality of life.  These side effects may include hot flashes, osteoporosis, weight gain, loss of muscle mass, and changes in sexual function.

Lifestyle changes to combat ADT side effects 

The best way to combat the negative side effects of ADT is by using certain medications for treating side effects but also by living a healthy lifestyle. Men who adopt “healthy living” changes are more apt to prevent or at least reduce the severity of side effects. 

Here’s a look at how healthy living can mitigate the side effects of ADT:

• Hot flashes

Hot flashes are not just a “woman’s problem” during menopause. Men on ADT can also experience the sudden feeling of being uncomfortably warm, often accompanied by sweating and flushing of the skin. Most men will have mild hot flashes that go away with time. It is not well understood why men on ADT have hot flashes. However, men whose testosterone levels gradually decline with age do not typically have hot flashes. Instead, hot flashes in men on ADT seem to be related to a sudden large decline in levels of testosterone and the hormone’s effect on blood vessels. 

Healthy lifestyle changes managing hot flashes: 

• Limit caffeine intake

• Avoid strenuous exercise

• Avoid warm temperatures or environments

• If hot flashes become very bothersome, ask your urologist to recommend medications to reduce them

• Osteoporosis

The brittle bone disease of osteoporosis also is primarily seen in postmenopausal women. However, men treated with ADT for prostate cancer are at a higher risk for decreases in bone mass and density, increasing the risk of bone fractures. Losing bone mineral density is a serious side effect of ADT. It’s important for men on ADT to periodically discuss with their doctor about getting a bone densitometry scan (DEXA) that measures bone mineral density to assess a man’s risk of osteoporosis.

Healthy lifestyle changes managing osteoporosis:

• Take supplements of calcium, vitamin D3, and magnesium. Calcium citrate has superior bioavailability and can be absorbed with or without food. Men ages 19 to 70 need 1000 mg of calcium daily, and 71 and older need 1200 mg per day.  19-70 require 600 International Units (IU)/day, while men aged 71 and older require 800 IU/day. Vitamin D promotes normal blood levels of calcium necessary to build and maintain strong bones. Magnesium is a mineral found in our bones. Bones become more brittle and prone to fractures when they lose magnesium. Men ages 19 and older need 420 mg/day of magnesium. 

• Best dietary sources of calcium include all dairy foods, broccoli, tofu, and calcium-fortified foods. 

• Best dietary sources of vitamin D include fatty fish (wild-caught salmon, tuna, mackerel), fortified milk, and egg yolks. Our skin can make vitamin D when exposed to sunlight.

• Best dietary sources of magnesium include green leafy vegetables, whole grains, and nuts.

• Weight-bearing exercises like strength training, jumping rope, dancing, jogging, or push-ups or pull-ups help build bone mass.

• Avoid smoking as it will reduce calcium absorption.

• Weight gain, loss of muscle mass, and fatigue

The use of ADT takes a toll on a man’s body, especially in the loss of muscle mass, weight gain, and fatigue. These metabolic side effects endanger a man of developing higher risks for heart disease and type 2 diabetes. 

Healthy lifestyle changes managing weight gain and loss of muscle mass

• Engage in aerobic exercise and resistance training which helps improve muscle mass and to lower inflammation that might lead to heart disease.

• Quit smoking. The toxic effect of tobacco smoke is greater in the absence of testosterone. 

• Take a daily walk to improve blood pressure and for weight loss. 

• Follow a low-carbohydrate diet to lessen the risks of atherosclerosis and heart disease and to have improvements in insulin resistance. 

• Sexual function changes

An unfortunate side effect of ADT treatment for prostate cancer can affect a man’s sexuality. Changes in libido, erectile dysfunction, and testicular size are the side effects some men may have. While there are various medications and treatments available for erectile dysfunction, certain changes in lifestyle may help too.

Healthy lifestyle changes managing sexual functioning 

• Becoming more physically active is a factor that may reduce adverse changes in sexuality and overall masculinity.
• Improving sexual communication and avoiding performance anxiety with a partner by seeking counseling.
• Prioritizing sleep routine and choosing healthy foods most of the time. 

Dr. David Samadi is the Director of Men’s Health and Urologic Oncology at St. Francis Hospital in Long Island. He’s a renowned and highly successful board certified Urologic Oncologist Expert and Robotic Surgeon in New York City, regarded as one of the leading prostate surgeons in the U.S., with a vast expertise in prostate cancer treatment and Robotic-Assisted Laparoscopic Prostatectomy.  Dr. Samadi is a medical contributor to NewsMax TV and is also the author of The Ultimate MANual, Dr. Samadi’s Guide to Men’s Health and Wellness, available online both on Amazon and Barnes & Noble. Visit Dr. Samadi’s websites at robotic oncology and prostate cancer 911.