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Hot flashes are a sudden wave of mild or intense body heat caused by rushes of hormonal changes resulting from decreased levels of estrogen. They can occur at any time and may last from a few seconds to half an hour. They are due to blood vessel dilation and constriction. Their frequency is increased in menopausal women and men receiving ADT.
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The "metabolic" or "insulin-resistance" syndrome (MetS) is a cluster of cardio-vascular (CV) risks related to insulin resistance [10,11]. Diagnosis of the syndrome is defined by the adult treatment panel III (ATP III) and the World health organization (WHO) as a combination of low HDL, increased waist circumference, increased triglycerides, increased fasting glucose and hypertension [11]. The syndrome itself is further associated with various metabolic abnormalities, including insulin resistance as well as other factors such as male hypogonadism [12].
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Insulin resistance is defined clinically as the inability of a known quantity of exogenous or endogenous insulin to increase glucose uptake and utilization in an individual as much as it does in a normal population [14].
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Cardiovascular events refer to any incidents that may cause damage to the heart muscle involving the heart and/or blood vessels which include: arterial embolic or thrombotic events, hemorrhagic or ischemic cerebrovascular conditions, myocardial infarction, and other ischemic heart disease. Severe CV events include conditions such as myocardial infarction or congestive heart failure which may be fatal [16].
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Osteoporosis is a skeletal disorder characterized by compromised bone strength predisposing to an increased risk for bone fractures. Bone strength reflects the integration of two main features: bone mineral density (BMD) and bone quality [18]. Osteoporosis is defined by the WHO as a BMD of 2.5 standard deviations or more below the mean peak bone mass (average of young, healthy adults) as measured by dual-energy X-ray absorptiometry (DXA). A BMD value allows fracture risk to be calculated using FRAX or CAROC assessment algorithms, which incorporate a group of clinical risk factors in addition to femoral neck BMD [19,20].
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The initial administration of an LHRH agonist first causes an increase of LH with a corresponding rise in serum T over 1-2 weeks. This increase in T may initially stimulate and worsen the disease and related symptoms. To prevent this phenomenon, administration of an anti-androgen or estrogen for one week before and during the first few weeks of LHRH agonist therapy is often employed.
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