Is ADT causing anemia?

@gently
In that case I ask, “who’s calling” ,ignoring what they said about a name. If it sounds like a legitimate call, then names are available.

Jeff, I was teasing Wayne a bit, because I called him and he said --yes, after hesitating. He wouldn't give over any of his bank account numbers though. He was suspicious.

Waynerl, I am so sorry to hear about your issues with prostate cancer, lung metastasis, and anemia. I hope that your physicians are able to resolve these issues to improve your quality of life. I appreciate your post because I was going to post my experience to get feedback.

I was diagnosed with oligometastatic PC last September and have been on Orgovyx/abiraterone/prednisone since early November. I was doing well in the first several months with the only significant side effect being occasional hot flashes. My PSA is 0.08 and my testosterone is <3. I've been maintaining a vigorous program of strength training and aerobic exercise. In July, my son and I attempted to reach the summit of Mt. Kilimanjaro but had to turn back after when my O2 saturation had dropped to 60% at the halfway point. More recently, I've been getting tired more easily especially later in the afternoon. In June 2025, everything was in the normal range. But starting in June 2026, I've had 3 CBC with differential done; my RBCs, hemoglobin, and hematocrit have been gradually dropping. At my last test, RBCs had dropped to 2.98 M/uL, hemoglobin was 9.6 g/dL, and hematocrit was 29.1%, all of which are well below the normal range. My medical oncologist at Cleveland Clinc said that the numbers "could be" a result to the ADT therapy but wanted to rule out other factors and recommended additional tests including TSH, haptoglobulin, reticulocytes, LDH, B12, folate, iron, iron-binding, iron saturation, and a peripheral blood smear. Everything was normal except that reticulocytes were very high (suggesting that my body is trying to make more RBCs but they're getting destroyed or lost somehow) and the peripheral blood smear indicated some possible abnormalities. Note: I was taking supplements including iron, B12 and folate; the latter 2 were high normal. My PCP ordered referrals for gastroenterology for a possible GI bleed and to hematology for the blood abnormalities.

Hoping to get some resolution soon. Wishing us all the best.

@stragale Stragale, sounds like we are having similar side-effects from ADT: hot flashes, lower oxygen and RBC levels. I don't feel well most of the time due to weakness and also because I have GI issues (IBS) from radiation treatments in 2010 for my original PC diagnosis. Take care friend. ~Wayne

Waynerl, I am so sorry to hear about your issues with prostate cancer, lung metastasis, and anemia. I hope that your physicians are able to resolve these issues to improve your quality of life. I appreciate your post because I was going to post my experience to get feedback.

I was diagnosed with oligometastatic PC last September and have been on Orgovyx/abiraterone/prednisone since early November. I was doing well in the first several months with the only significant side effect being occasional hot flashes. My PSA is 0.08 and my testosterone is <3. I've been maintaining a vigorous program of strength training and aerobic exercise. In July, my son and I attempted to reach the summit of Mt. Kilimanjaro but had to turn back after when my O2 saturation had dropped to 60% at the halfway point. More recently, I've been getting tired more easily especially later in the afternoon. In June 2025, everything was in the normal range. But starting in June 2026, I've had 3 CBC with differential done; my RBCs, hemoglobin, and hematocrit have been gradually dropping. At my last test, RBCs had dropped to 2.98 M/uL, hemoglobin was 9.6 g/dL, and hematocrit was 29.1%, all of which are well below the normal range. My medical oncologist at Cleveland Clinc said that the numbers "could be" a result to the ADT therapy but wanted to rule out other factors and recommended additional tests including TSH, haptoglobulin, reticulocytes, LDH, B12, folate, iron, iron-binding, iron saturation, and a peripheral blood smear. Everything was normal except that reticulocytes were very high (suggesting that my body is trying to make more RBCs but they're getting destroyed or lost somehow) and the peripheral blood smear indicated some possible abnormalities. Note: I was taking supplements including iron, B12 and folate; the latter 2 were high normal. My PCP ordered referrals for gastroenterology for a possible GI bleed and to hematology for the blood abnormalities.

Hoping to get some resolution soon. Wishing us all the best.

@stragale Stagale, I hope that you have success in resolving your blood count issues.

I too have low hemoglobin, not as severe as you have, but troublesome to me. Your problem appears to be loss of red blood cells after they have been created. My problem is that the production of red blood cell is not sufficient to maintain hemoglobin above anemia levels.

In the first 2 years of ADT my hemoglobin dropped from 13.5 to an average of 12.6, which I find from research is the normal effect of ADT. It then proceeded on down to 11.2. I brought this to the attention of my oncologist and he referred ma to a hematologist on the staff of the provider group. A test indicated that the kidneys were not producing sufficient Erythropoietin to stimulate the bone marrow to make an adequate number of red blood cells. I attribute the damage to the kidneys to the ADT treatment, although I found there is little information on this in the literature.

The plan of the hematologist is to monitor the hemoglobin levels and when if falls below 10, and I am symptomatic for anemia, to use erythropoiesis-stimulating agents (ESAs) to raise the hemoglobin level modestly. The hematologist warned the ESAs can cause blood clots and other cardiac events. The FDA black box for an EAS drug has this at the beginning;

WARNING: ESAs INCREASE THE RISK OF DEATH,
MYOCARDIAL INFARCTION, STROKE, VENOUS
THROMBOEMBOLISM, THROMBOSIS OF VASCULAR ACCESS
AND TUMOR PROGRESSION OR RECURRENCE

Not a very good indication.

Recently I saw some articles that mentioned that patients with chronic kidney disease and or diabetics have modest increases in hemoglobin from the use of Sodium-Glucose Transport 2 (SGLT2) Inhibitors. The increase is about 0.7 g/dL, admittedly small but any gain in my book is good. I showed the articles to the oncologist, he asked if I was willing to take the medication, and when I said yes he refereed me to the endocrinologist on the staff of the group. The endocrinologist said he never prescribed the medication for the purpose of raising the hemoglobin, but if I was willing to try it, he would prescribe it.. Now I am in my first week of taking Dapagliflozin (Farxiga®) 5 mg tablets. I won't know the results for at least a month and perhaps 4 months.

Since the SGLT2 Inhibitors require prior approval by my insurance plan I may not be reimbursed for the cost of this medication. Since I am outside of the United States the cost per month is about $30, whereas in the United States the cost would be several hundred dollars per month.

@stragale Stagale, I hope that you have success in resolving your blood count issues.

I too have low hemoglobin, not as severe as you have, but troublesome to me. Your problem appears to be loss of red blood cells after they have been created. My problem is that the production of red blood cell is not sufficient to maintain hemoglobin above anemia levels.

In the first 2 years of ADT my hemoglobin dropped from 13.5 to an average of 12.6, which I find from research is the normal effect of ADT. It then proceeded on down to 11.2. I brought this to the attention of my oncologist and he referred ma to a hematologist on the staff of the provider group. A test indicated that the kidneys were not producing sufficient Erythropoietin to stimulate the bone marrow to make an adequate number of red blood cells. I attribute the damage to the kidneys to the ADT treatment, although I found there is little information on this in the literature.

The plan of the hematologist is to monitor the hemoglobin levels and when if falls below 10, and I am symptomatic for anemia, to use erythropoiesis-stimulating agents (ESAs) to raise the hemoglobin level modestly. The hematologist warned the ESAs can cause blood clots and other cardiac events. The FDA black box for an EAS drug has this at the beginning;

WARNING: ESAs INCREASE THE RISK OF DEATH,
MYOCARDIAL INFARCTION, STROKE, VENOUS
THROMBOEMBOLISM, THROMBOSIS OF VASCULAR ACCESS
AND TUMOR PROGRESSION OR RECURRENCE

Not a very good indication.

Recently I saw some articles that mentioned that patients with chronic kidney disease and or diabetics have modest increases in hemoglobin from the use of Sodium-Glucose Transport 2 (SGLT2) Inhibitors. The increase is about 0.7 g/dL, admittedly small but any gain in my book is good. I showed the articles to the oncologist, he asked if I was willing to take the medication, and when I said yes he refereed me to the endocrinologist on the staff of the group. The endocrinologist said he never prescribed the medication for the purpose of raising the hemoglobin, but if I was willing to try it, he would prescribe it.. Now I am in my first week of taking Dapagliflozin (Farxiga®) 5 mg tablets. I won't know the results for at least a month and perhaps 4 months.

Since the SGLT2 Inhibitors require prior approval by my insurance plan I may not be reimbursed for the cost of this medication. Since I am outside of the United States the cost per month is about $30, whereas in the United States the cost would be several hundred dollars per month.