There is a rarely discussed, but well know association between low androgen levels and anemia in men on ADT. The underlying cause of anemia in men on ADT is believed to be the low levels of testosterone and dihydrotestosterone in the body.
Dr. Strum et al. examined the severity of anemia in patients on ADT. He found that up to 90% of patients’ experienced mild anemia (at least a 10% decline in hemoglobin) while 13% experienced severe anemia (a 25% decline in hemoglobin). This decline in hemoglobin rates developed as quickly as one month into the therapy, but the mean nadir was 5.6 months. (Strum SB, McDermed JE, Scholz MC et al., “Anemia Associated with Androgen Deprivation in Patients with Prostate Cancer Receiving Combined Hormone Blockade”, Br J Urol, (1997) pp. 933-941).
Patients who were severely anemic were successfully treated by administering Recombinant Human Erythropoietin (EOP). EOP is a hormone produced by the Kidney, which promotes the manufacturing of red blood cells (hemoglobin) in the bone marrow.
Dr. Strum has recommended that hemoglobin levels be monitored every two to three months. However, most physicians do not routinely monitor hemoglobin levels on their patients who are receiving ADT. If your doctor does not routinely monitor your levels, you should insist that they start. In addition, if you begin to tire even more easily then normal, ask for a hemoglobin level to be taken as this is often a symptom of low hemoglobin levels.
Joel T Nowak MA, MSW
Prostate cancer UK and everyone one else I have spoken to, doctors nurses and specialist have all seen me very white and pale, have seen a 33% drop in red blood cells when tested but because my normal level is high, and now “only” 9.6 (I was 15.1 before starting the hormone treatment, I know because I have leukaemia and it was tested in October). My kidney function is about half the normal level for my age (65) since it fell after a heart bypass 6 years ago and never really picked up again.
I was told it was very unusual to get anaemia from the hormone treatment (one nurse said she was experienced but had never seen it) . I feel truly terrible, even going up one stairs flight I nearly faint and a normal shopping walk around a supermarket leaves me feeling weak and breathless. The fall in HB occurred when the initial tablets stopped and a few days after the first injection. (I have been told that was co-incidence…but I am an experienced engineer and don’t believe in such things).
One other relevant item is I have Addison’s disease and had been on testosterone replacement therapy for some 12 years (which was stopped one the cancer was discovered). I say this because I assume my hormone level would have fallen faster than someone not on such therapy, as I didn’t make enough normally(which was why they originally put me on it).
I don’t feel very cared for, let alone very well. Any suggestions as to how I approach my doctors (I assume they are intelligent and have chosen not to tell me what you have written above, surely they must know about it?)
Thanks