Metabolic Complications of Androgen Deprivation Therapy for Prostate Cancer

GnRH agonist associated sarcopenic obesity. GnRH agonists increase abdominal cross-sectional area primarily through accumulation of subcutaneous fat. Cross-sectional images of young healthy man (A) and of obese man receiving long-term GnRH agonist therapy (B). Note relative paucity of abdominal and paraspinal musculature, and accumulation of subcutaneous fat.

Insulin sensitivity decreases during GnRH agonist therapy. Glucose and insulin levels throughout oral glucose tolerance test. Data are taken at baseline (circles) and after 12 weeks of androgen blockade (squares).¹⁹

GnRH agonists are associated with significant excess risk of diabetes, coronary heart disease, myocardial infarction and sudden death. Largest excess risk is for diabetes (44%).³²