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