Fatigue and Hormone Therapy

PCRI’s Executive Director, Mark Scholz, MD, discusses a range of solutions for alleviating fatigue brought on by androgen deprivation therapy (also known as testosterone inactivating pharmaceuticals or TIP).

0:10 Fatigue is the most common side effect experienced by men undergoing androgen deprivation therapy, and it is most often the result of reduced muscle mass caused by the lack of testosterone.

0:44 The best way to counteract fatigue from treatment is to have a consistent devotion to exercising, specifically weightlifting, 2-3 times per week. Significant muscle mass loss can occur in as little as two weeks, so any lapse in your weightlifting regimen can have serious negative consequences including reintensifying fatigue. Typically, consistent and diligent weightlifting will reduce the amount of fatigue that men experience by about 80%.

2:07 There are other possible causes for fatigue while taking androgen deprivation therapy (e.g. Low thyroid levels, low B12 levels), and so it is important that your doctor is checking for these rather than assuming that the source of fatigue must be from the lack of testosterone.

2:30 On rare occasions the absence of testosterone may cause anemia to occur. If anemia becomes severe then cardiorespiratory reserve is reduced and shortness of breath with minimal exercise will occur. Most cases are mild and do not require treatment, however, if it becomes severe (usually signaled by hemoglobin less than 10 or a hematocrit under 30%) then pharmaceutical agents like Aranesp or Procrit can restore blood levels to an acceptable range. Transfusions have greater risks and should not be considered unless the situation is horribly severe.

3:31 Other solutions for treatment-related fatigue include the use of caffeine or Provigil (modenafil), a stimulant-like medicine typically used to treat narcolepsy. These are most effective when they are used occasionally so that your body will become acclimatized to their absence and their effectiveness will be reestablished.

4:15 Another thing to consider is the pharmaceutical agent(s) that are being used for the androgen deprivation therapy and the duration of treatment. A shorter duration of treatment might be appropriate for elderly men with milder forms of cancer who are experiencing extreme fatigue. Xtandi is more associated with fatigue than its most similar competitor Zytiga, so it is worth considering switching if Xtandi is causing fatigue. Casodex is an oral agent that has less potent anti-cancer efficacy than injectibles like Lupron, but it also causes significantly fewer side effects. In elderly patients or patients with severe fatigue, Casodex is worth considering as a substitute for the stronger injectible agents.

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