Synthetic progestogens (administered orally or parenterally) are recommended as first-line ther- apy for the management of troublesome hot flushes. If oral therapy is used, it should be given for 2 weeks, and re-started, if effective, on recurrence of symptoms. Men starting long-term bicalutamide monotherapy ( 6 months) should receive prophylactic radiotherapy to both breast buds within the first month of treatment. A single fraction of 8 Gy using orthovoltage or electron beam radiotherapy is recommended. If radiotherapy is unsuccessful in preventing gynaecomastia, weekly tamoxifen should be con- sidered. Inform men starting androgen withdrawal therapy that regular resistance exercise reduces fatigue and.
