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ADT fatigue- How bad can it get for some men?

Posted by datasource @datasource, Jul 15 1:21pm

I started Firmagon 4 months ago, and am just beginning radiation this week. Localized 4+3, PSA at diagnosis was 28, now down to 0.66. Testosterone is <10.

All I want to do is lay down on the floor and crawl into fetal position, I am so fatigued. I can microwave a dinner, or do dishes, but in 10 minutes I want to go back to bed. I'm 73, was reasonably energetic (not a jock, though)... but i do have a history of bad depression fatigue in past.

The oncologist has checked everything blood and thyroid-wise, no real red flags.

Can the low T cause fatigue this severe? If I only do a year of Firmagon might I have a reasonable hope of energy in the future? Cause I can hang in there if this is the price of healing.... but it should would help to hear a "yep, been there, done that" from somebody.

Interested in more discussions like this? Go to the Prostate Cancer Support Group.

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jbristow3682 | @jbristow3682 | 11 hours ago

I'm on 18 months of ADT - half way done. Fatigue is real, and tough to combat. I'm 65 and playing softball 2-3 times a week and I can tell you flat out I'm slower; get tired easier; and just have zero energy out on the field. I attribute all of that to ADT and the 13 lbs I've added on as a result of ADT. Bottom-line: ADT is a mother!

Everything I've read points to exercise; weights and resistance training as the best way to combat it - but those are the very things that exhaust me these days. But every day I get up and am determined to exercise in some manner to offset the fatigue. I can't say it works 100% to get rid of it - but I know if I sit around and do nothing the fatigue and side effects will get worse.

Keep up the fight...continue to walk your 3 miles and do whatever else you can to be activity.

You've got this. 🙂

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jbristow3682 | @jbristow3682 | 11 hours ago
In reply to @northoftheborder "I was on Firmagon for 2½ years before switching to Orgovyx. They're both GnRH antagonists —..." + (show)
Profile picture for northoftheborder @northoftheborder

I was on Firmagon for 2½ years before switching to Orgovyx. They're both GnRH antagonists — so they work the same way — but I found Orgovyx (daily pills) MUCH easier to tolerate than Firmagon (monthly injections).

For me, the problem with Firmagon was the acute symptoms around each monthly injection: swelling at the injection site, 2–3 days of flu-like symptoms (fatigue, muscle ache, borderline fever, etc), and then a gradual recovery before we repeated the whole cycle.

Those vanished when Orgovyx became available in Canada in early 2024. I'd say that switching from Firmagon to Orgovyx was the biggest single quality-of-life improvement I made since my diagnosis in 2021.

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@northoftheborder I start Orgovyx next week. 18 months on ADT - I tolerated 3 Lupron injections for the first 9 months. Every time it was extremely painful at the injection site for the first 7-10 days - to the point of barely being able to sit down - and most importantly my heart rate would jump up and stayed elevated for that same time period. I showed my Oura Ring results which tracked the heart rate to my doctor and he switched me out to Orgovyx. Can't wait to start it.

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Jeff Marchi | @jeffmarc | 10 hours ago
In reply to @anything4him "I think fatigue varies greatly. My husband has a very hard time with fatigue and is..." + (show)
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I think fatigue varies greatly. My husband has a very hard time with fatigue and is on Orgovyx & Abireterone.
Some days we can get in a great workout, others he’s completely exhausted. Some days a long walk - others days a short one. And yes, some days he just can’t and he needs a full rest day. He used to exercise hard every day before our cancer journey started so it’s difficult for him.
If you have had depression fatigue previously I’d discuss it with your doctor. Battling cancer takes a lot out of you, physically and emotionally.
Wishing you all the best

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@anything4him
Abiraterone Can cause serious fatigue problems for some people. Prednisone can make a big difference in that fatigue. Usually, the doctor starts off with 5 mg of prednisone but 10 mg is also a standard dose. Increasing prednisone to 10 mg can usually make a big difference in fatigue since it will restore the cortisol that has been lost by taking abiraterone.

A doctor at one of the conferences talked about his fatigue and increasing prednisone to resolve it.

Ask your doctor about this, Request an increase in prednisone.

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anything4him | @anything4him | 9 hours ago
In reply to @jeffmarc "@anything4him Abiraterone Can cause serious fatigue problems for some people. Prednisone can make a big difference..." + (show)
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@anything4him
Abiraterone Can cause serious fatigue problems for some people. Prednisone can make a big difference in that fatigue. Usually, the doctor starts off with 5 mg of prednisone but 10 mg is also a standard dose. Increasing prednisone to 10 mg can usually make a big difference in fatigue since it will restore the cortisol that has been lost by taking abiraterone.

A doctor at one of the conferences talked about his fatigue and increasing prednisone to resolve it.

Ask your doctor about this, Request an increase in prednisone.

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@jeffmarc Thanks Jeff! I’ll definitely ask about that. Appreciate you!!

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pesquallie | @pesquallie | 2 hours ago
In reply to @rbtsch1951 "I am on month 7 of planned 12 month Orgovyx (started 12/2025) though I had a..." + (show)
Profile picture for rbtsch1951 @rbtsch1951

I am on month 7 of planned 12 month Orgovyx (started 12/2025) though I had a single 3-month Lupron injection 9/2026 as I was receiving SBRT. The midday fatigue and aching musculoskeletal pain in my legs/feet are getting progressively worse, not easing, as time passes. I exercise daily (Zumba, occasional elliptical, bicycling, walks, and Pilates) by ignoring the pain and pushing through. It strikes me that the next few months will be difficult. My PSA has come down from 15.1 ng/ml to 0.04 ng/ml and my testosterone, of course, is <10 ng/dL. Some days I wonder if I can make it, but I don’t want to shortchange the opportunity for ADT to achieve its fullest effect.

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@rbtsch1951

I had similar pain issues and could only tolerate 4 months of Lupron because of this severe pain. I am now about to begin TRT (Testosterone Replacement Therapy) after 12 months of PSA < 0.1. I am 84 years old and started with Gleason scores of 3+4, 3+4, 3+4, and 4+4 from 12 cores. My PSA was 11.0 and my testosterone was only 280 to start with and only recovered to 111 after a year without Lupron.

Recent articles are now questioning the true correlation between testosterone and prostate cancer. There is a growing consensus that low testosterone does not always help reduce cancer risk but does cause health issues demonstrated by side effects. Below are three articles I have read

For Advanced Prostate Cancer: Immunotherapy and… Testosterone? | Johns Hopkins Medicine 11/12/21

Testosterone and prostate cancer: What's the connection? - Mayo Clinic
Conclusion: Studies have shown that testosterone replacement therapy doesn't seem to increase the risk of prostate cancer returning. 10/29/25

Testosterone Supplementation After Prostate Cancer Treatment
YouTube - ISSM International Society for Sexual Medicine - Dr. Mohit Khera (Baylor College of Medicine) and Dr. Gerald Brock (Western U. London) explain the evolving view on testosterone and prostate cancer, noting a shift from seeing testosterone as harmful to recognizing potential therapeutic or preventive roles. Low testosterone is linked to higher risk of high-grade cancer, recurrence, and poorer erectile recovery. 3/28/25

Everyone is different and more test work needs to be done but you need to discuss all options with your doctor.

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