Preventing muscle atrophy

He will have some muscle loss, especially if he was in peak fitness before -- that's almost inevitable with testosterone deprivation. It sounds like your spouse is doing everything right to minimise that.

I'm almost 4 years on ADT now, and I did manage to recover from the severe muscle atrophy during the months that I was paraplegic from spinal compression (my legs were like sticks), but I accept that I'll never be back to where I was before. It least I'm able to maintain muscle and bone mass on a plateau now with regular exercise.

Yes, you can live well, energetically, and joyfully with prostate cancer. But it changes you. Unfortunately, for many people, it's not something one can just shrug it off and resume their old life as if it had never happened. 🙁

Being a gym rat, I managed my own weightlifting and cardio regimen without the need for a personal trainer.

My exercise regimen was quite intense - 6 days/wk for at least 1-1/2 hours each day - to try to maintain strength and muscle mass (to offset the Eligard side-effects). I split the routines so as not to repeat muscle groups each day. On alternating days, I would also add some cardio - either jog 3-4 miles or swim 35-45 minutes. (On the 7th day I rested…..)

I changed my diet —> Decreased red meats; increased fish, salads; added more fruits, vegetables, and grains/nuts; cut out soft drinks; cut back on processed foods, and made other tweaks here and there. I also added a protein/fruit smoothie every morning, and a protein bar & two energy bars every day. (I think that was helpful in sustaining energy and endurance during the months of low-testosterone.)

Even with all that (based on my own tracking), along with a noticeable loss of muscle mass, I experienced about a 30% loss of strength. I also lost 40 lbs (3 belt sizes), which was an expense in buying new clothes.

(However, I did not experience the mood swings, emotions, fatigue, forgetfulness, confusion, memory loss, insomnia, night sweats, etc., things that are typically mentioned. So from that aspect, my exercise regimen was a success.)

As my strength dropped (due to the loss of testosterone), I had to reduce the weights I was lifting so as not to injure myself (muscles and joints) during that time. (He should always listen to his body. Setting expectations as to what’s possible while on ADT is important.)

ADT has significant metabolic effects, As long as your husband’s testosterone is being suppressed, he will have challenges maintaining muscle mass. (My testosterone level dropped to 3.0 ng/dL, but generally remained in the upper single digits to low double digits.)

Once his testosterone levels return to normal, he’ll be fine.

(I recall telling my wife (in late January 2022), that I thought the Eligard was wearing off because I was beginning to lift heavier weights at the gym. Since I wasn’t due for another “official” bloodwork for another couple of months, I self-ordered another PSA & testosterone test (out of curiosity), and those came back as 0.13 & 403.0, respectively, meaning that everything was going exactly as expected - that is, PSA staying low and testosterone increasing as the Eligard was leaving my system. The muscle mass, and strength all slowly returned.)

Y'all inspired me to go to the gym today. I felt like crap, but I went anyway, and worked out for a full hour.

Thanks

My situation is unusual because I also had the spinal compression, nerve damage, and paraplegia, but I know the ADT + Apalutamide also play a role. My experience:

- Light workout: feelin' good
- Moderate workout: feelin' GREAT!
- Intense workout: crash and burn (no energy for days, stiffness, soreness)

So the trick for me is remembering to stop at "moderate", because when I feel great, I naturally want to push on to "intense"; but with the hormone deprivation (and nerve damage), I no longer have a body that knows how to process "intense", so instead of building me up, it just shuts me down.

It's the Goldilocks Effect: we need to figure out as individuals how much lifting is just right.

https://pmc.ncbi.nlm.nih.gov/articles/PMC9997646/
In prostate cancer patients, resistance exercise training counteracts the adverse effects of ADT on body composition, muscle mass, muscle strength, and aerobic capacity, with no additional benefits of protein supplementation."

So far not exactly my experience-4 months on ADT and I think at best I have mitigated some muscle loss.Throuh rigoros dieting, I've lost a couple pounds, but I'm guessing that is due to some muscle loss . BUT- I am quite sure if wasn't rigorous about it I'd have gained weight and all of it flab.

Yes, the phrasing can be misleading: "counteracts" ≠ "cancels out.". That's why I prefer the term "mitigates."

Yes - always listen to your body. Setting expectations as to what’s possible while on hormone therapy is important.

Alternative exercises, like using your own bodyweight, TRX, or taking a water exercise class (which is what I did at one point; the buoyancy helped). There are many resistance-training alternatives to weightlifting.

I am a life long weight lifter, when diagnosed last July with stage 4, and immediately put on ADT, I was told to exercise and lift weights to mitigate ADT side effects. Since this was already my daily routine, I just continued my normal lifting routine. I was in the gym the day after getting Firmagon injections in my stomach. I woke up in a fog that morning, but still went to the gym. It felt strange at first, but after a few exercise sets the fog disappeared. The first two months were hard, fatigue would set in and I had to push myself to the gym, However, the fatigue is very minimal and now, after 9 months. I have actually put on a good deal of muscle and gotten stronger on all my lifts. I am 72 and just about as strong as when I turned 50. I lift 4 days per week and walk about 3 miles each day, I do have weird joint and muscle pains off and on, but they only last a few minutes and disappear with movement. Each morning I psych myself up with positive thoughts and hit the gym. I just keep telling myself that this PC won’t get me down,
My best advice to everyone here is to keep your mind strong and positive.

That's a great mindset, John. Thanks for sharing it.