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[Clinical Picture] Hypogonadism from androgen deprivation therapy in identical twins

A 76-year-old man presented to the andrology clinic for assessment and management of side-effects associated with androgen deprivation therapy, which he was about to start for treatment of prostate cancer. His identical twin had started androgen deprivation therapy for localised prostate cancer 1 year previously, and since then the twins had no longer looked identical (figure). Our patient’s twin reported that he was more easily fatigued, had intermittent hot flushes, and noted increasing abdominal girth since starting androgen deprivation therapy.