It sounds like you need a better radiation oncologist. I respect that they're busy, but you have a right to information, since it's your life.

I'm also on ADT "forever" (initially Firmagon, now Orgovyx), together with an ARSI (Erleada). After a couple of years, they did get easier to tolerate for me — part of that was the side-effects getting milder, and part was me getting used to them and recovering enough from the spinal metastasis to get active again.

I hope you see a similar improvement, though I understand you're dealing with a different set of complications. As I mentioned in another thread, our cancers are coach-built, not mass-produced — every one is different, so what you hear from the rest of us is just a range of possibilities to keep in mind.

Good luck.