JNF said...
Same reasons that women have different levels of response to menopause. People are different and there will be variations in response to the same treatment. <snip> However, no two men have exactly the same rate of metabolism and thus the specifics will vary among individuals.
Yes certainly, different folks and different strokes when comparing experience between individuals.
But I'm referring to the difference each individual may experience relative to each of their own multiple episodes. As an example, I've spoken to individuals on long term ADT who say their hot flashes can be considered nearly debilitating on some occasions, while on others they might only rise to a level characterized as minor flushing. Once lowered to the level of medically castrate, at least to my inexperienced thinking, it doesn't seem unreasonable to believe that one's own side effects would show a more consistent pattern. But I guess that would be too easy, lol.
I also find it interesting that ADT for prostate cancer is a 'one size fits all' dosing and does not lend itself to low dose titration. On one hand, the primary goal in ADT is to have the medication work quickly and completely so by design initial doses are ones that must work for most patients. That is in contrast to most conditions, where an immediate response to drug treatment is rarely needed and side effects are dose-related. On the other hand, three-quarters of reported side effects of medications are found to be dose related and, when medications are first marketed, the recommended starting doses are typically much higher than those eventually found to be effective.
That is a lot of patients unnecessarily tolerating side effects or potentially stopping a medication that might otherwise have been helpful without adverse events at a lower dose... so I still wonder if there is a wide dose–response relation with the HT drugs we are prescribed.