Also called: Androgen deprivation therapy side effects; ADT sarcopenia; hormone therapy for prostate cancer
Exercise is the main treatment
Strength
Balance
Androgen deprivation therapy removes testosterone on purpose - and testosterone is what holds muscle and bone in a man. Fat rises, strength and balance fall, and the fracture and fall risk climbs, all within months.
How common: About half of men with prostate cancer receive hormone therapy at some point; they lose 2-4% of lean mass and 2-8% of bone in the first year
What it is
Androgen deprivation therapy suppresses testosterone to treat prostate cancer. It works, and the collateral effects are substantial and rapid: muscle mass falls, fat rises particularly around the middle, bone density drops, and fatigue and hot flushes make moving harder at exactly the point movement matters most.
Bone loss on this treatment is faster than in postmenopausal women, and fracture risk rises measurably within the first year. Resistance and impact training is the intervention with the best evidence against all of it, and it is offered far less often than it should be.
What it feels like
- Strength declining noticeably within months of starting
- Weight gain, particularly around the middle, with muscle visibly reduced
- Fatigue, hot flushes and reduced motivation
- Loss of libido and erectile function
- Reduced balance and confidence, and sometimes falls
What causes it
Most people have more than one of these at once, and they feed each other. Read the
list looking for the two or three that sound like your week rather than for the one
true answer — the ones that describe you are the ones worth acting on.
- Testosterone suppression
- Testosterone maintains muscle mass and bone density in men. Removing it deliberately removes that maintenance, and the effects appear within months rather than years.
- Accelerated bone loss
- Bone density falls faster on androgen deprivation therapy than in postmenopausal women, and fracture risk rises measurably in the first year. Bone monitoring and protection should be part of the treatment plan.
- Muscle loss and fat gain
- Lean mass falls and fat mass rises, particularly visceral fat. The body composition change drives the metabolic effects as well as the functional ones.
- Reduced activity from fatigue
- Fatigue is common and severe, and it reduces activity at exactly the point when loading is what would protect muscle and bone.
- Insulin resistance and metabolic change
- Androgen deprivation raises insulin resistance and adverse lipids, contributing to increased cardiovascular risk - which is a leading cause of death in men on long-term treatment.
- Falls and reduced balance
- Loss of muscle and reduced confidence both affect balance. Combined with weaker bone, the fracture risk rises from both directions at once.
- Age
- Most men on this treatment are older and already losing muscle and bone. The treatment accelerates a decline that was already underway.
- Duration of treatment
- The effects are dose and duration dependent. Men on long-term or lifelong treatment accumulate substantially more loss.
- Low vitamin D and calcium
- Common in this age group and directly relevant given the bone loss. Both are routinely supplemented alongside the treatment.
- Nobody prescribing exercise
- Exercise is recommended in guidelines for men on androgen deprivation therapy and it is offered to a small minority. It is the largest missed opportunity in this treatment.
Who tends to get it
- Any man on androgen deprivation therapy for prostate cancer
- Men on long-term or lifelong treatment, in whom the effects accumulate
- Older men, who start from a lower muscle and bone baseline
- Anyone with pre-existing osteoporosis or previous fractures
- Men who become inactive because of the fatigue
What makes it worse, and what settles it
Makes it worse
- Doing no resistance training during treatment, which is the usual situation
- Reducing activity because of fatigue and hot flushes
- Ignoring bone density monitoring
- Low protein intake at a time of accelerated muscle loss
- Waiting until treatment finishes, since much of the loss happens in the first year
Settles it
- Resistance training two or three times a week, which is the best-evidenced protection for muscle, bone and function
- Impact and weight-bearing exercise where safe, for the bone specifically
- Aerobic exercise, which addresses the raised cardiovascular and metabolic risk
- Balance training, given the raised fall and fracture risk
- Adequate protein, calcium and vitamin D, and bone monitoring as part of the treatment plan
What actually helps
The short version: The treatment removes testosterone on purpose, and testosterone is what holds muscle and bone in a man. Fat rises, strength and balance fall, fatigue and hot flushes make moving harder, and the fracture and fall risk climbs - all within months
Strength work: Full Body; Weight Training; Legs: Quads; Glutes: Max; Legs: Hamstrings; Back: Lats; Chest: Pecs; Hands, Fingers, Grip - two or three supervised-style progressive sessions a week, heavy enough to be hard by the last repetitions
Stretching: Full Body; Hips: Flexors; Chest
Massage: Not primary
Also worth doing: Protein at every meal; calcium and vitamin D as the team advises; a bone density scan at the start of treatment; impact work such as brisk walking and step-ups if the bones are sound; the balance items, because a fall on thin bone is the thing to avoid
What the evidence says: Randomized trials consistently show resistance training during androgen deprivation therapy preserves or increases lean mass and strength and improves fatigue and quality of life, and it is recommended as standard care in oncology exercise guidelines. A 2024 study found the gains from a 20-week supervised program were lost within a year of stopping - it has to become permanent.
The names above are the Targets qFIT tracks —
the Muscle Guide explains what each one does, and
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Ready-made routineStrength & Bone for Aging
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strength — the order that works on a body that is already sore — and every
activity in it carries the reason it is there.
The button below opens your Checklist with this routine already selected, so instead
of your whole list you land on just its Categories, Targets
and Exercises, each with its checkbox, ready to tick as you work through
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Get it checked if…
New bone pain, especially in the back, hips or ribs, or any fracture from a minor fall - oncology review before loading; chest pain or breathlessness on exertion - cardiology, this therapy raises cardiovascular risk
And whatever the body part: chest pain or unusual breathlessness on
exertion; a fever alongside the pain; unexplained weight loss; pain that is constant and
unrelated to how you move; new numbness, weakness or loss of bladder or bowel control; or
one calf that is swollen, warm and painful. Any of those, stop and get assessed.
How it usually goes
Resistance training preserves muscle mass, strength, function and bone density in men on androgen deprivation therapy, and it improves fatigue and quality of life at the same time. The benefits appear within twelve weeks and require continuing. Because most of the loss happens in the first year, starting at the same time as the treatment rather than afterwards makes a substantial difference - which is worth asking the oncology team about directly.
Prevalence basis: Body-composition trials in men on androgen deprivation; ACSM exercise oncology guidance
Others the same routine covers
These share the Strength & Bone for Aging routine, so the work is the same. If one of them also
sounds like you, that is a reason to expect more from it, not less.
This is general information, not a diagnosis, and it cannot examine you.
If it matches you, use it to ask better questions of a clinician rather than to replace one.