"Orgovyx and Lupron work almost exactly the same. I’ve been on both of them. There’s been no difference in any reaction/side effect."

True: the side-effects of low testosterone are similar, regardless of what's causing it.

The main difference is that Orgovyx is a GnRH receptor antagonist like Firmagon (they both block glands from receiving gonadotropin to stimulate testosterone production) while Lupron is a GnRH analogue or agonist (it mimics gonadotropin to desensitise the glands).

The downside of a GnRH agonist is that it causes an initial testosterone surge before the testosterone falls, and that is potentially a huge problem if your prostate cancer is already in a precarious situation (e.g. my metastasis was compressing my spinal cord); in that case, a GnRH antagonist like Firmagon or Orgovyx is a safer choice. There are some ways to block that surge with additional medications, but they still delay the actual testosterone *reduction*, so it's still longer before your cancer can start responding with Lupron than it is with Firmagon or Orgovyx.