/ Updated December 3rd, 2025

Androgen Deprivation Therapy: Rethinking Long-Term Impacts and Evolving Patient-Centered Care

: Dr. Nima Aghdam Medical Source: Dr. William Tester
Thomas Jefferson University Written by: Kavontae Smalls

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Navigating The Long-Term Impacts Of Androgen Deprivation Therapy

Once considered an indefinite treatment, androgen deprivation therapy (also called hormone therapy) is now being reassessed in light of its long-term physical, mental, and sexual health impacts on prostate cancer patients.
Dr. William Tester, professor of medical oncology at Thomas Jefferson University’s Sidney Kimmel Cancer Center, emphasizes individualized care, noting that patients prioritize different aspects of wellness — from sexual function to bone health — and the best approach to treatment, and the decision to start or continue ADT, depends on patient preference.
Exercise, especially weight training, is highlighted as a critical strategy to counteract ADT’s side effects and support overall health.
In advanced prostate cancer patient cases with a favorable response, Dr. Tester monitors patients’ serum prostate-specific antigen (PSA) levels and imaging to determine if and when ADT can be safely interrupted.

In prostate cancer care, androgen deprivation therapy (ADT), also called hormone therapy, has long been considered an essential tool to slow disease progression by reducing testosterone levels. However, many clinicians and researchers are reexamining its long-term use, recognizing that while men are living longer, they are also living with the complex consequences of extended hormone suppression and the side effects it brings.

“Long-term side effects of androgen deprivation therapy (ADT) are somewhat of a mixed blessing,” Dr. William Tester, professor of medical oncology at Thomas Jefferson University’s Sidney Kimmel Cancer Center, tells SurvivorNet. “Men are living much longer and bearing the consequences of long-term ADT.”

Dr. Tester notes that in the past, patients were expected to stay on ADT indefinitely, but there are other options now, and the patient’s preferences and goals should absolutely be taken into consideration when planning the treatment path.

Weighing Benefits vs. Long-Term Impacts

Patients facing prostate cancer may think of hormone therapy as the only option, assuming that once it’s started, it continues without pause. But as survivorship increases and treatment protocols evolve, Dr. Tester acknowledges the importance of reevaluating its impact across various stages of patient health.

“Times have changed,” Dr. Tester says. “I’m open-minded enough to realize the consequences of this type of treatment on men’s mental health, physical health, sexual health, cardiovascular health, and bone and muscle health. So, we really are dealing with the consequences of therapy and ways to try to mitigate that.”

Personalized medicine is an important component of finding the right treatment. Dr. Tester emphasizes that no two patients respond — or prioritize — their wellness in quite the same way. While some men are deeply focused on preserving sexual function, others are concerned about bone strength or cardiovascular risks. It is a balancing act grounded in conversation and guided by lifestyle changes.

“Different men will view things quite differently,” Dr. Tester says. “We talk about taking care of your bones, your muscles, and some lifestyle changes. Exercise and weight training, I think, are important for men when they start ADT, and we kind of work through it as we go.”

An Evolving Mindset For Treatment

The evolving mindset also applies to late-stage disease. For men diagnosed with advanced prostate cancer, individualized assessment is also key. Dr. Tester explains that for patients with low-volume disease who respond well to therapy, indefinite treatment (staying on ADT long-term) may be unnecessary.

“I don’t treat them forever,” he shares. “I kind of assess and look at our parameters like the prostate-specific antigen (PSA) level and the imaging, and make a conscious decision to interrupt therapy when they are in a good remission.”

Prostate-specific antigen is a protein produced by cells in the prostate gland and then released into the bloodstream.

As prostate cancer care evolves, there is a clear movement toward survivorship-centered approaches — where extended life expectancy is matched by thoughtful attention to well-being.

It’s important to remember that ADT keeps patients alive despite its side effects. If ADT is on the table, consider some alternatives to make it easier, such as taking breaks using intermittent therapy, using focused radiation to treat a few sites of disease with a short course of ADT, and considering agents that do not suppress testosterone but block its pathway and have a different but somewhat more tolerable side effect profile.

Questions To Ask Your Doctor

What long-term side effects should I expect from ADT, and how can we manage them proactively?
What lifestyle changes — like exercise or diet — can help reduce the impact of hormone therapy?
Are there different treatment options or newer approaches that might reduce my need for long-term hormone therapy?
How will we monitor my progress and decide when it is safe to adjust or interrupt treatment?
Content independently created by SurvivorNet with support from Novartis Pharmaceuticals Corp.

Content independently created by SurvivorNet with support from Novartis Pharmaceuticals Corp.

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Kavontae Smalls is a writer and reporter for SurvivorNet. Read More