Sexual effects

Drug / Class Typical symptom Management
ADT / GnRH analogs Erectile dysfunction, libido loss PDE-5 inhibitors, vacuum device, counseling
AIs (women) Vaginal dryness, dyspareunia Non-hormonal moisturizers, lubricants
SERMs Decreased libido, hot flushes SSRIs (citalopram, venlafaxine) if severe

Cognitive and mood changes

  • “Androgen brain fog,” mild memory loss, depressive symptoms in 30–40 % of ADT users.

  • Evaluate with PHQ-9 or HADS scales.

  • Encourage aerobic exercise, cognitive training, social contact.

  • Consider SSRIs/SNRIs if persistent.

Body-image and relationship counseling

  • Integrate partner in discussion; address sexual identity concerns early.

  • Offer psycho-oncology or sex-therapy referral.

(ESMO Psycho-Oncology 2024)

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