Surgical castration (also known as bilateral orchiectomy)

This operation removes the testicles, which are the main source of testosterone. It lowers testosterone levels quickly and permanently. It is a simple procedure, but it cannot be reversed.

LHRH agonists

These are long-acting hormone injections. They can be given once a month, every 3-6 months, or once a year.

They gradually lower testosterone levels over 2-4 weeks. This is the most common type of hormone therapy.

LHRH antagonists

These medicines also lower testosterone, but they work more quickly.

Degarelix (monthly injection)
Relugolix (oral tablet)

Anti-androgens

These medicines do not lower testosterone levels. Instead, they block testosterone from binding to the androgen receptor inside prostate cancer cells.

Examples include:

Bicalutamide
Flutamide
Nilutamide

They are sometimes used together with injections.

Newer hormone-blocking medicines (androgen receptor pathway inhibitors ARPIs)

These are stronger medicines that block the effect of testosterone more completely.
They are mainly used for advanced or metastatic prostate cancer.

Examples include:

Abiraterone (always taken with a low dose of steroids such as prednisone or prednisolone)
Apalutamide
Darolutamide
Enzalutamide

Related topics for further reading