After initially rejecting hormone therapy, I agreed to a six-month injection of androgen-deprivation medication. My injection is scheduled for August 23.
My main concern in preparing for life without testosterone is mitigating the significant side effects of not having male hormones. Like avoiding or minimizing depression, weight gain and the effects of increased metabolic syndrome.
Possible symptoms of androgen deprivation include:
- Reduced sexual desire, reduction in size of the penis and testicles
- Erectile dysfunction
- Bone weakening that can lead to fractures, osteoporosis, pain and other issues
- Anemia
- Cognitive issues
- Behavioral issues like depression and anxiety
- Cardiovascular morbidity, damage to the heart
- Metabolic syndrome (increased insulin resistance, weight gain, especially around the waist, increased cholesterol, increased blood pressure)
- Body feminization, increase in size of breasts, breast tenderness, loss of muscle mass
How I am preparing for hormone therapy
Nutrition
My first step, something that I started even before I received my cancer diagnosis, was to be conscious of my daily nutrition and supplements. This includes vitamin D3 for bone strength, fish oil for cholesterol and mood stabilization, and ginseng for energy.
Sobriety
Some sources follow the general recommendations for daily drink maximum (one for women, two for men) but I feel like any alcohol is going to have a negative effect.
Medication
I scheduled an appointment with my primary care physician to get prescriptions to help mitigate some of the anticipated side effects.
Duloxetine (Cymbalta) – To help with depression, body aches and diabetic nerve pain. I had taken this previously with good results, except for serious sexual side effects. Now those won’t be a concern, since I will be sidelined for at least six months anyway.
Statin – to treat increased cholesterol and triglycerides. In the past few years I have generally been able to control my cholesterol with diet and exercise. But recently both HDL and LDL were out of range, and androgen deprivation will exacerbate that. I had resisted taking a statin for many years due to reports of aches and pains (which will hopefully be offset by Duloxetine), but this time I am willing to give a statin a try.
Hypertension medication – a bump in my current dosage. I take 100mg of Losartan in the morning, but my systolic pressure has been high (145 – 150) in the evening and early morning. So my physician prescribed another blood pressure medication to take at night.
Behavioral health support
Depression and anxiety are two of my major concerns about the potential side effects of this therapy. To add some support through this process I arranged an appointment with a psychiatrist to help with my behavioral health issues and medication.
Cancer can itself be depressing, and more so with the side effects of hormone therapy. So, arranging for professional behavioral health care is a priority for me.
Exercise and fitness
Another priority, especially in avoiding muscle loss and additional belly fat.
Yesterday I discovered that one of the great benefits of my health plan is a free gym membership. Today I went to Planet Fitness, signed up and did an initial light workout. I had a whey protein shake when I got home, and three hours later by blood glucose was 90.
I have an appointment with a physical trainer on Friday to develop a fitness plan to focus on areas I am concerned about – maintaining muscle mass and bone strength, and avoiding weight gain.
I want to work out as much as possible in the next two weeks, to get into the habit of going to the gym. Hopefully that will help to motivate me going forward, especially when fatigue begins.
I also signed up for an arthritis aquatics class at a community pool that starts on September 9.
Writing
I am trying to write as many of my core posts and pages as I can before any cognitive effects of the therapy take hold. So, if my blog posts start to lose their edge and focus a bit, you will know why. I am hopeful that keeping my mind active by writing will help to mitigate any serious cognitive issues. But for some reason I keep thinking about the short story Flowers for Algernon.
Conclusion
I may be completely over-reacting to the potential side effects. But in this situation and given my personal physical and behavioral health history, I would rather be prepared that wait to see how I am affected by not having testosterone.
I will be blogging about how the therapy affects me. And I am hopeful that ultimately this will be a positive experience.