A simple answer to this question is that the long-term psychological side effects of ADT are the same as those of short-term ADT. This conclusion is based on a recent study out of Germany that looked at a variety of psychological parameters for men who had been on ADT between 5 and 267 months (average ~40 months). The researchers compared prostate cancer patients on ADT to other patients not on ADT and to healthy controls. The sample size was small; just 68 men were included in the study (15 men on the standard LHRH agonist drugs, 9 men on non-steroidal anti-androgens, 22 men with prostate cancer who were not on ADT, and 22 men without prostate cancer).
In terms of cognitive function, the men on androgen suppressing medication showed a small but statistically significant decline in visual spatial performance. In terms of mood, men on ADT were slightly more likely to report symptoms of depression.
One unique aspect of this study was the examination of men’s performance on a version of what’s called the “ultimatum game". This game explores the willingness of individuals to cooperate as a group (“in-group cooperation”) and/or to act with hostility toward others who are outside their group (“out-group hostility”). Typically, men who have high testosterone levels are more likely to be cooperative with their in-group (their troop, their team) and act hostile toward outsiders. This is the first study to show that men on ADT tend to be less hostile to out-group members. While this is not surprising, we look forward to future studies that examine further the social implications of ADT with a larger sample size.
These results highlight the responsibility healthcare providers have to inform patients that ADT may affect their cognitive function, mood, and perhaps even their social sensitivities. Importantly, clinicians need to ensure that men severely bothered by ADT receive support as needed.
To read the study abstract, see: https://pubmed.ncbi.nlm.nih.gov/32539186/
Holtfrerich, S.K.C., Knipper, S., Purwins, J., Castens, J., Beyer, B., Schlomm, T., & Diekhof, E.K. (2020). The impact of long-term androgen deprivation therapy on cognitive function and socioeconomic decision making in prostate cancer patients. Psychooncology. Epub ahead of print.