Enzalutamide Myths: — Chemo, Fatigue and Losing Your Masculinity

It is a type of chemotherapy

This confusion is understandable: both are cancer treatments given in clinic, and both are associated with fatigue. But the mechanisms are completely different. Chemotherapy targets rapidly dividing cells throughout the body, which is why it causes hair loss, nausea and immune suppression. Enzalutamide is an androgen receptor inhibitor — a hormonal therapy that blocks the receptor prostate cancer cells use to respond to testosterone. The side effect profiles differ for exactly this reason.

It will make me lose my hair

This fear comes directly from the chemotherapy association. Hair loss on chemotherapy happens because it damages hair follicles, which are rapidly dividing cells. Enzalutamide does not work that way. Significant hair loss is not an expected side effect. Some thinning is possible with long-term hormonal therapy over time, but that is a different thing from the hair loss people experience on chemotherapy cycles.

The fatigue means the cancer is growing

This is one of the most distressing misunderstandings. Fatigue on enzalutamide is a direct pharmacological effect of reducing androgen activity — androgens support energy levels, and when their effect is blocked, tiredness follows. It is a known, expected effect of the drug, not a sign that disease is progressing. Your team monitors response using PSA measurements and imaging, not how tired you feel.

It will feminise me or make me less of a man

This belief comes from knowing that enzalutamide reduces the effect of testosterone. Some effects of long-term androgen suppression — breast tenderness, hot flushes, changes in body composition — are real and worth discussing with your team. But enzalutamide does not change your gender or your identity. Those are manageable side effects, not a redefinition of who you are.

Sexual changes mean I will never recover normal function

Reduced libido and erectile difficulties are recognised effects of androgen-suppressing therapy, and the assumption that these are permanent partly comes from the fact that they can be significant while treatment continues. Whether and how much function returns depends on many individual factors your oncologist can discuss with your history in mind. Assuming permanent loss before that conversation closes options unnecessarily.