Does ADT Reduce Ones Sense of Balance? - Prostate Cancer N...

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Does ADT Reduce Ones Sense of Balance?

rmarkley profile image

As a hiker, I have found that ADT has reduced my sense of balance. Before I got PCa, I did a lot of mountain climbing, which required a reasonable sense of balance. Since I got PCa, and was put on ADT (currently Orgovyx and abiraterone plus prednisone) I have found my sense of balance has been reduced. On a recent hike, admittedly on slippery leaves on rocks, I took a minor tumble and, while fortunately landing on my pack, I managed to bruise the lower ribs on my left side. An x-ray showed that nothing was broken. I finished the hike, but needed to use one of my wife's trekking poles. She has used poles for several years, but I have never felt the need for them. My Christmas present from me to me this year is going to be a set of Leki Makalu Lite Cor-Tec trekking poles.

I guess the big question here is has anyone else had their sense of balance lowered by ADT. To reduce the side effects of ADT I try to bike or hike daily on alternate days. An hour or so of biking or a 3-4 mile hike.

21 Replies

It seems you lose your edge all over.

So this makes sense.

Might want to wind back a bit. Your bones break more easily for sure.


Wassersug et al, "Androgen Deprivation Therapy: An Essential Guide . . ", second edition, p. 48:

"One of the most important benefits of a regular exercise program is the maintenance of good balance, which reduces the risk of falls. Your exercise program could incorporate activities specifically designed to maintain and improve balance such as:

. . Walking on a ine (heel to toe) or on your toes

. . Balancing on one foot

. . Walking backward or sideways

. . Tai chi or yoga.

Note: These exercises do put you at a risk of a fall; therefore, they should first be attempted near a chair of railing that you can hold on to if you start to fall."

Your muscles may be losing strength. Especially in demanding situations, that's going to make it more difficult to keep your balance.

. Charles (without personal experience of ADT, and no letters after my name).

In the "Advanced prostate cancer" group, many of us (including me) have brought up the loss of balance issue regarding being on ADT as well as aging. Good idea you're getting a walking stick (also get a cane while you're at it)....

No more Jack be nimble .....

Good Luck, Good Health and Good Humor.

j-o-h-n Sunday 11/14/2021 1:00 AM EST

4.5 years of ADT and I'm definitely more of klutz generally, and have had several falls.

Been on ADT for 8 weeks and during those weeks, I had major dizzy spells. Usually in the morning or when exercising from a high position to a lower position. They came on quick and thankfully stopped.

While on ADT, I lost my balance and fell a number of times while walking around the neighborhood. It seemed that a crack in the sidewalk or uneven pavement that I didn't see ahead of time would send me flying to the pavement. I attributed this to loss of muscle tone in my core, which reduced my ability to right myself if I stumbled only a little bit. More attention to core exercise (and quads) went a long way toward reducing this problem, but it didn't fully go away until I was off the meds.

rmarkley profile image
rmarkley in reply to jazzy53

I also find myself tripping on minor elevation changes in pavement or on hiking trails. I find I have to concentrate on picking up my feet a bit more. As long as I do that, I trip less.

Hey there - I'm on ADT (Lupron) and I'm still climbing strong. Been leading 10a outside and 10d inside and up to 11c as the second. I don't see any balance issues - still hiking and mountain biking strong as well.

Before I started ADT I got a trainer and work with weights more than I ever had - he puts me through the paces once a week with "homework" for me another day. I think this has helped.

65 yo, 2 lesions contained in prostate, Gleason 4+5, ADT for 18 months, IMRT, Brachy

rmarkley profile image
rmarkley in reply to conbio

I am impressed with your climbing. The best I could do was lead 5.7 and follow 5.8 back in the mid 70/s and 80's when I was about 25 to 35 years old. That was at the Gunks in New Paltz, NY and Cannon in NH. Did trade routes in the Tetons and some snow climbing in the Northern Selkirks in BC. Climbed Denali in 1961 for our honeymoon. Some trade routes in the Alps also, but nothing too serious.

Stopped climbing when we had our son. Too many of the folks we climbed with, all far better climbers than I, had died in climbing accidents, so we had to get responsible.

ADT 16 months, IMRT 2 1/2 months into ADT. Gleason 3+4. A couple of small mets in the left hip.

conbio profile image
conbio in reply to rmarkley

Ha! In Seattle for 35 years but learned to climb at the Gunks! Planning on a climbing trip there next October, if all goes well. Cheers.

The subject interests me because I find that mindfulness is now required when walking. Locomotion used to be an autonomous event. Now when I walk, I'm alert to the possibility of needing to quickly take corrective action.

In my case, I deliberately keep vitamin B12 low. B12 deficiency will likely affect balance. It's worth checking that B12 levels are adequate.

But I believe that ADT is the reason in my case.

This is from a paper that is off-topic [1], except for this:

"Potential confounders included ... comorbidities associated with fracture or falls (diabetes, lung disease, stroke, Parkinson's, seizures, etc.) and medications associated with fracture or falls (bisphosphonates, glucocorticoids, androgen deprivation therapy [ADT], proton pump inhibitors [PPIs], selective serotonin receptor inhibitors [SSRIs], etc.)."

ADT therapies that drive estradiol [E2] below 12 pg/mL will inevitably cause bone loss . (Of course, this does not happen if E2 itself, at supraphysiological levels, is used to drive down testosterone levels.) A fall with weak bones can sometimes lead to death. If balance is an issue, I feel that it is prudent to check bone density & E2, and consider a low-dose add-back E2 patch for bone health. Don't forget the vitamin K2, magnesium, zinc, boron, etc. Calcium (at moderate levels) is just one part of bone health.

I remember a Jane Brody column in the NY Times [2], 11 months ago, where she discusses “Falling Is Not an Option: A Way to Lifelong Balance" by George Locker [3]. He is not a professional expert but this might help:

"A sample lesson: You’ve likely heard advice to improve balance by standing on one leg when you brush your teeth. A far better plan is to bend the knee and ankle of the leg you’re standing on to engage the postural muscles. At the same time, the pelvic muscles remain relaxed. If added support is needed, use the tips of the fingers of one hand on the sink or wall, but keep in mind that the goal is to stand without support, using the wall only for balance.

"Another simple exercise involves standing straight with thigh and buttocks muscles relaxed, then bending knees and ankles as if you’re about to sit on a high stool. Keep the spine straight and pelvis relaxed. Hold this position for as long as you can, increasing the time gradually as your postural muscles get stronger, up to 15 minutes."





rmarkley profile image
rmarkley in reply to pjoshea13

A question - why do you keep your B12 low? It is poorly absorbed anyway, so one gets a very small fraction of what is in various vitamin pills.

I flunked a Dexa scan taken to establish a baseline when I was starting ADT. As a result, my calcium and Vit D levels were increased, and I was put on Xgeva (denosumab) every 12 weeks.

Since I am on coumadin as a result of my lone atrial fibrillation, I cannot take Vit k, since it counteracts the blood thinning feature of coumadin. I take all the other suggested vitamins and minerals.

I am also on metoprolol xl to help control my heart rate. When I went on ADT, my blood pressure increased(not a surprise) so my cardiologist increased my metoprolol dosage from 50 mg / day to 75 mg/day. The toprolol really clamps my heart rate. Hard to get it over 125-130. Makes it hard to bike up steep hills

I went for a 3.8 mile hike along a quite hilly local road this afternoon. One thing I find is I need to keep track of sand and gravel on the road surface, especially when going down hill. Easy for your feet to slide out in front and drop you to the pavement. My poles should help that. Hike took 1 hour. Not bad. A few years ago I could do it in 50 minutes, but as I get older, I get a bit slower. 82 now.Apparently my hospital has some balance courses. I am going to research that.

Hiking is great but not enough by itself.

Train your legs! Without strength training your legs (as a man especially your legs) will deteriorate rapidly when older. The ADT just exacerbates it. Same with balance work. All old people need it, we on ADT need it more.

rmarkley profile image
rmarkley in reply to London441

Please recommend the leg training that has worked for you. With colder temps approaching, I am going to have to go back to the gym at the local Y

London441 profile image
London441 in reply to rmarkley

Sure. Squats, deadlifts, lunges and calf raises are the best and most common leg exercises.

On the other hand, machines like leg press, leg curl, extension etc are often used instead by people who are intimidated by any of the basic free weight exercises, which is fine.

Personally, I don’t mind machines but even if I were deconditioned I would still use the basic moves. Squats can be done as wall squats, or with no weight. Deadlifts can be effective even with very light weight. Especially if you do enough of them!

However, poor form sometimes gets people hurt, especially older people. If you are unsure and can’t easily get guidance on that, again the machines are fine.

What works for me is fairly intense, but I am experienced. I have to work really hard for the slightest improvement.

The great news for someone who doesn’t lift, or hasn’t for a long time is that strength gains are dramatic and come swiftly if one is consistent.

Yes, definitely! I am on Lupron, Zytiga and prednisone for one year now and my balance has deteriorated. I recently did an eight day cross country train trip and I could barely walk when I got home. Took me two days to get my land legs back!

Took me awhile to figure out the flowmax was causing me to be lightheaded when I stood up. That’s one. Weak legs from muscle loss doesn’t help me either.

Sounds like you are doing very good keeping your muscles strong. Fatigue must not be much of a problem for you. That’s great. Wish I could say the same.

rmarkley profile image
rmarkley in reply to carlo8686

I have been on Flomax for a long time. When I started, I was told to take the pills at night, and when I got up in the morning, I could hardly stand up. It really lowered my blood pressure. Figured out that if I take them in the morning, a half hour after breakfast, there was no problem, and it seemed to work just as well. When I had my ADT associated radiation, flow was reduced, and the docs put me on 2 Flomax a day, AM and PM. No obvious affect on blood pressure. The only thing I don't like about Flomax is the rumors that it can lead to dementia in the future. My stream is thin enough I would like to take 2 Flomax, but I am forgetful enough as it is-age (82) and ADT, and I don't want to compound the problem.

I do get dozy in the late afternoon if I am just sitting around, but if I am working on a project, it seems not to bother.

Hope you are wrong on the flowmax and dumb down. I’m dumb enough but still have to pee and can’t without 2 a day. I’m pretty sure my off balance is a result of muscle weakness and I gained a lot of peripheral numbness in my feet that makes them feel like they are quishey if that’s a word.

rmarkley profile image
rmarkley in reply to carlo8686

Because of the ADT meds, and weakened muscles due to low T, I finally had to resort to a pair of hiking poles. They make walking much easier and more stable. My wife has been using poles for years, and I finally broke down an bought a pair of Leki Makalu Lite Cortec from Recreational Eqpt.

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