The Orgovyx was not awful, but not a lot of fun, either - I'm glad to be going off it.
Hot flashes started after the first week. Mine seem to alternate with chills - five minutes of sweating (like, dripping down my neck sweating) followed by a few minutes of shivering. This has been an on-again, off-again phenomenon. I'll go a week or two with nothing bothersome, and then they'll be back for a few days. Exercise seems to help. Hot beverages and alcohol seem to be triggers (for me).
Difficult to achieve an erection after about a month on the drug. A little distressing, but since it also drove my interest in sex to zero, not a big deal (after I explained the situation to my wife). But I am hoping that this will improve going forward.
Significant weight gain (~20 lbs, from a starting point of 195 lbs) - mostly in my midsection. I'm pretty sure I've lost muscle mass - so the 20 lb weight gain is probably more than 20 lbs of fat. Tried to maintain an exercise regimen, but between the fatigue/laziness from the Orgovyx and the winter blahs, it was hit-and-miss. (And I've never liked the weight room anyway.) That's something I hope to work on over the next few months.
I'll find out next month how my kidneys, liver and blood sugar are doing - all of that was fine a year ago.
Yes, managing ADT SEs is a challenging slog.
Best wishes