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Men whose cancer has metastasized to their bones may have some bone pain. If the cancer has spread to his spine, even a brief increase in growth could compress the spinal cord and cause pain or paralysis. Doctors can prevent flare by prescribing anti androgens for a few weeks when treatment begins. Physicians may use the female hormone estrogen to counter testosterone production. Due to estrogen's possible side effects, such as blood clots and breast growth, estrogens have been replaced with anti androgens and other drugs. Estrogens may be tried, though, if androgen deprivation is no longer working. Occasionally, doctors will remove the testicles. This stops the hormones from fueling more cancer growth. More than 90 percent of androgens, mostly testosterone, are made in the testicles. Surgery can be done on an outpatient basis, and is probably the least expensive and easiest way to reduce androgen levels. It is permanent, though, and many men have trouble accepting the lack of testicles, often because of how it looks. Surgeons can implant artificial silicone sacs, which look like testes, into the scrotum. Hormone therapy has some undesirable side effects, including lower or no sexual desire, impotence, hot flashes which may be temporary, breast tenderness and growth, osteoporosis, anemia, less mental ability, muscle mass loss, weight gain, fatigue, higher cholesterol levels, depression, high blood pressure, diabetes and even heart attacks. While anti androgens have similar side effects, they seem to have less effect on the libido. If anti androgens are used alone, libido and potency often aren't affected. If these drugs are combined with LHRH analogs, however, diarrhea, nausea and liver problems may occur. Most men can take hormone therapy safely for several years. Inevitably, though, most prostate cancers can grow with few or no male hormones. 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