Physical Conditioning While On Androgen Deprivation Therapy

Even when your body has depleted its testosterone, you can gain muscle mass

One of my biggest fears about having prostate cancer was that I’d be going on a regimen of Androgen Deprivation Therapy (ADT) that would keep my body from making testosterone, which is what the prostate tumor needs to survive, and what the effects of no testosterone would mean for me.

It’s not pretty.

The side effects of ADT and Anti-Androgen blockers are

• Loss of muscle mass.

• Increased body fat.

• Loss of sex drive.

• Not being able to get or keep an erection, called erectile dysfunction.

• Bone thinning, which can lead to broken bones.

• Hot flashes.

• Less body hair, smaller genitals and growth of breast tissue.

• Tiredness.

• Diabetes.

• Heart disease.

In other words, my biggest fear was turning into this guy.

So I started researching the effects of exercise on patients with prostate cancer. And what I discovered was that the conventional wisdom about needing testosterone to build muscle was wrong.

YOU DO NOT NEED TESTOSTERONE TO BUILD MUSCLE!

It was important, however, to start training before or at the start of ADT, at least insofar as loss of bone density was concerned.[1]

Further, you don’t need to go to a gym, which is especially important if you’re immuno-compromised. You can get the same benefits at home if you’re diligent about it.[2]

Aerobic exercise and resistance strength training are key to counteracting the effects of ADT.[3]

My Workout

Aerobic Exercise

For aerobic exercise I use a Concept II Rower at least four days a week, 30 to 40 minutes a day. I started with a ten minute session, then worked my way up slowly. I chose a rowing machine because of my arthritic knees. I literally can’t do any other type of exercise without a lot of knee pain getting in the way. You should do whatever you enjoy, or at least whatever gets you to sweat during your workout. The “sweating” part is key from what I’ve been told.

Strength Training

I didn’t want to buy a bunch of home gym equipment, and, as it turns out, that’s not really necessary to increase muscle strength and size. You can get many of the same benefits using a system that leverages angles and your own body weight - TRX Suspension Training.

I love this product. There’s a huge variety of different exercises that you can do, and as long as you keep the intensity high, it doesn’t take a lot of time to see results.

I use it at least four days a week. Five sets of five repetitions to muscle failure with 30 seconds in-between sets.

Online Pilates Classes

Pilates is an amazing core workout. TRX includes some Pilates movements among its exercise options, but I recommend that you find an online instructor that you like and include it in your weekly regimen. I do Pilates two to three times per week, 60 minutes per session, with a live instructor that my wife and I are friends with, but there are lots of Pilates resources online that you can explore such as Move With Nicole.

Summary

Frequent exercise at the right intensity combats a lot of the side effects of Androgen deprivation including fatigue, muscle loss, bone density loss, and your overall psychological health. If you have prostate cancer, you need to be working out, or the side effects are going to make your life miserable.

NOTES:

[1] Taaffe DR, Galvão DA, Spry N, Joseph D, Chambers SK, Gardiner RA, Hayne D, Cormie P, Shum DHK, Newton RU. Immediate versus delayed exercise in men initiating androgen deprivation: effects on bone density and soft tissue composition. BJU Int. 2019 Feb;123(2):261-269. doi: 10.1111/bju.14505. Epub 2018 Sep 21. PMID: 30239116; PMCID: PMC6635752.

[2] Brown M, Murphy MH, McAneney H, McBride K, Crawford F, Cole A, O'Sullivan JM, Jain S, Prue G. Feasibility of home-based exercise training during adjuvant treatment for metastatic castrate-resistant prostate cancer patients treated with an androgen receptor pathway inhibitor (EXACT). Support Care Cancer. 2023 Jul 4;31(7):442. doi: 10.1007/s00520-023-07894-1. PMID: 37402060; PMCID: PMC10319656.

[3] Houben LHP, Beelen M, van Loon LJC, Beijer S. Resistance Exercise Training, a Simple Intervention to Preserve Muscle Mass and Strength in Prostate Cancer Patients on Androgen Deprivation Therapy. Int J Sport Nutr Exerc Metab. 2023 Dec 4;34(2):122-134. doi: 10.1123/ijsnem.2023-0075. PMID: 38048764.