The psychological impact of androgen deprivation therapy (ADT) in prostate cancer
Prostate cancer is the most common type of cancer in men and has become the third most common cause of cancer death in the UK, with almost 12,000 men dying from it every year, slightly more than the number of women who die from breast cancer. Compared to White men, African Caribbean men are three times more likely to develop the disease and tend to do so at a younger age and in a more aggressive form.
Similarly to estrogen in some types of breast cancer, testosterone is associated with the development and course of prostate cancer. Androgen Deprivation Therapy (ADT) is a commonly used treatment for advanced prostate cancer, although it may also be used to treat disease confined to the prostate. Up to 50% of men being treated for prostate cancer may receive ADT. It reduces symptoms and increases survival times by stopping testosterone production. However this causes a range of serious side effects, including erectile dysfunction, genital shrinkage, loss of libido, hot flashes, osteoporosis, loss of muscle mass, breast enlargement, anaemia, fatigue, risk of diabetes, risk of cardiovascular disease and of potentially fatal cardiac events. ADT has also been linked with an increased risk of developing some types of dementias, though findings are inconsistent and the increased risk appears to be small.
ADT can impact mental health too. For example, it may increase mood swings and tearfulness. Depression may also occur as a result of testosterone reduction and the associated problems.
Understandably, some of these physical and mental symptoms can impact a man’s sense of his masculinity. Compared to patients having what might sound like more radical treatments (e.g. prostatectomy or radiotherapy), patients on therapy with hormones have relatively low HRQoL scores.
Not all studies are in agreement (perhaps due to differences in methodology), but there is evidence that ADT is also linked to impairment to executive cognitive functioning, causing problems in planning, initiating and sequencing goal-directed behaviours, and memory issues. Further research is required on this issue. There is also some evidence that because of the reduction in testosterone, men on ADT perform less well in spatial cognitive abilities.
In conclusion, prostate cancer treatment with ADT has a range of psychological implications for men and their partners. Some of these implications are in need of further research, especially treatment-related decision making, survivorship and the experiences of men from ethnic and sexual minorities.
This article was first published on the Male Psychology Network website in 2019.
Scroll down to join the discussion
Disclaimer: This article is for information purposes only and is not a substitute for therapy, legal advice, or other professional opinion. Never disregard such advice because of this article or anything else you have read from the Centre for Male Psychology. The views expressed here do not necessarily reflect those of, or are endorsed by, The Centre for Male Psychology, and we cannot be held responsible for these views. Read our full disclaimer here.
Like our articles?
Click here to subscribe to our FREE newsletter and be first
to hear about news, events, and publications.
…people – men and women alike – respond less positively to male-favouring sex differences than they do to female-favouring sex differences.
hyper-masculine gender norms are typically embedded within military institutions, and while adherence to these norms can contribute to combat and military success, they conversely make clinical work challenging
Men might benefit greatly from a government strategy aimed at improving their health. Here are suggestions from the Centre for Male Psychology on how that might be done. This article ends with some comments on potential pitfalls in the process of putting this strategy in place.
…people – men and women alike – respond less positively to male-favouring sex differences than they do to female-favouring sex differences.
… many papers do not even bother to identify or justify the nationality of their samples…
hyper-masculine gender norms are typically embedded within military institutions, and while adherence to these norms can contribute to combat and military success, they conversely make clinical work challenging
There is social power, there is structural power, and there is physical power. What women have in our society is the power of the state behind them, and men do not. Men only have that physical power, and most men don’t want to use it
people are more aware of the fact men can be victims of this type of violence, but this often isn’t translated into policy, practice or indeed provision of resources
Therapists can work effectively with men experiencing distress without asking them to change. Telling them they are ‘doing masculinity wrong’ is judgemental and victim blaming.
people are more aware of the fact men can be victims of this type of violence, but this often isn’t translated into policy, practice or indeed provision of resources
people are more aware of the fact men can be victims of this type of violence, but this often isn’t translated into policy, practice or indeed provision of resources
people are more aware of the fact men can be victims of this type of violence, but this often isn’t translated into policy, practice or indeed provision of resources
Have you got something to say?
Check out our submissions page to find out how to write for us.
hyper-masculine gender norms are typically embedded within military institutions, and while adherence to these norms can contribute to combat and military success, they conversely make clinical work challenging
hyper-masculine gender norms are typically embedded within military institutions, and while adherence to these norms can contribute to combat and military success, they conversely make clinical work challenging
hyper-masculine gender norms are typically embedded within military institutions, and while adherence to these norms can contribute to combat and military success, they conversely make clinical work challenging
hyper-masculine gender norms are typically embedded within military institutions, and while adherence to these norms can contribute to combat and military success, they conversely make clinical work challenging
hyper-masculine gender norms are typically embedded within military institutions, and while adherence to these norms can contribute to combat and military success, they conversely make clinical work challenging
Much of our attitudes, theorizing and public debate around men and masculinity is influenced by high profile feminist and Gender Studies scholars in academia. But what is the scientific quality of publications from these scholars?
Some people blame drill music – a form of rap - for the rising murder rate in London. Drill is known for aggressive lyrics about gang violence, but rather than seeing this as a valuable way for young men to express their feelings, some people want to ban it.
To survive… cultures have to use men and women effectively and … in fact, most cultures have used men and women in different ways… what our culture does is [grant] greater status to men and greater protection to women
hyper-masculine gender norms are typically embedded within military institutions, and while adherence to these norms can contribute to combat and military success, they conversely make clinical work challenging
There are around 300,000 veterans living with hearing loss in the UK, according to The Royal British Legion. In addition to being at a greater risk of PTSD, depression, and anxiety, many vets are also battling psychological distress from hearing problems.
The book begins with a description of her therapeutic approach, and an illustration of how to understand and work with the rage often seen in male CSA clients.
I felt in my dealings with some police officers, as though I were treated firstly as a man (assumed to be a perpetrator), but they’d overlooked risks associated with my impairment. Example: How can you dodge a missile you don’t see coming?
The Panorama programme on domestic violence failed to adequately highlight two important issues: male victims and female perpetrators.
your photograph, name and address, might appear in the local and national press and on TV, insinuating what an evil monster you are
…an attack upon masculinity is an attack upon one’s sense of self, of identity. …What, then, is the right psychological defence against such an attack?
The male has been designed to “look”, not only at the female, but to “look out” for prey, for danger, and for ways to protect his family unit.
If his child is allowed to live, this man must be available, for the rest of his life, to love and provide for his child… If, on the other hand, it is decided that his child is to be destroyed, he should be able to go about his life as if nothing has happened
Socialising is a basic human need. The opposite – social isolation – is one of the worst forms of torture. Some people look down on the local pub as a place for undesirable riff raff, but that narrow viewpoint misses entirely the community value of the pub
Male psychology is a recent development in academia. Unlike gender studies, feminism, and men’s studies, male psychology takes the view that we can gain more by recognising and harnessing the positive aspects of masculinity than we can by taking a relentlessly negative approach to men.
.
Dr Kenneth Gannon is the Clinical Research Director and Research Degree Leader at the University of East London. Ken presented his work at the 2015 Male Psychology Conference at University College London (UCL). His book chapter will appear in the forthcoming Handbook of Male Psychology: Theory and Practice (Palgrave Macmillan) in 2019. Contact here.
Dr John Barry is a Psychologist, researcher, clinical hypnotherapist & co-founder of the Male Psychology Network, BPS Male Psychology Section, and The Centre for Male Psychology. Also co-editor of the Palgrave Handbook of Male Psychology & Mental Health, and co-author of the new book Perspectives in Male Psychology: An Introduction (Wiley).
When a male is in a power imbalance, at least two masculine instincts are disempowered…