ENHormone therapy for cancer in Germany means almost the opposite of what the words suggest: hormones are not added; the tumour’s access to them is cut off. That is why it only works in tumours that depend on hormones.
Below: how that dependence is established, what is used in breast and prostate cancer, how long treatment lasts, how it affects wellbeing and how it differs from hormone replacement therapy in the menopause, which replaces missing hormones. The general page covers cancer treatment in Germany.
How it is established that a tumour depends on hormones
The answer comes from the tissue, not from a blood test: the pathologist looks for oestrogen and progesterone receptors, the cells’ docking points for these hormones, and reports the result as a percentage. In prostate cancer no separate receptor test is needed: virtually all such tumours depend on testosterone from the outset.
In breast cancer, the HER2 status (an excess of a growth-driving protein) and Ki-67, a measure of how fast cells divide, are also checked. In borderline cases, a gene expression test helps decide whether hormone therapy alone is enough or chemotherapy is needed too. In Germany a tumour board, not one doctor, makes that decision.
This matters before the trip: if the receptors were never tested at home or the tissue block was not kept, the discussion starts with re-examining the material, which has to be built into the schedule.
Breast cancer: what is used
Three groups are used: tamoxifen, aromatase inhibitors and suppression of the ovaries. Tamoxifen blocks the receptor against oestrogen. Aromatase inhibitors shut down oestrogen production in the tissues, which take over from the ovaries after the menopause. In younger women, the ovaries can be suppressed by injections that switch off the brain’s signal to them. The choice follows menopausal status, not the age in the passport.
Treatment lasts years: a tablet every day, not a course with an end in sight, and that is the main difference from chemotherapy. In some women it is extended, depending on the risk of the disease returning.
Side effects have to be lived with: hot flushes, joint pain, effects on bone density, mood changes. German centres treat this as part of the treatment: bone density is monitored, and a poorly tolerated drug is changed, not endured. More under breast cancer treatment in Germany.
Prostate cancer: what is used
The logic is the same: remove the testosterone supply, with drugs that stop the brain’s signal to the testes, usually injections, and drugs that block the receptor in the tumour itself. Surgical removal of testicular tissue is rarely used today.
Hormone therapy fits before and during radiotherapy, in advanced disease and when a blood test shows the disease returning after surgery. Importantly, it is usually not the only treatment here but part of a plan with radiotherapy or drug therapy.
The side effects are real: loss of libido, hot flushes, weight gain, loss of muscle and bone, effects on mood and memory. The German approach is to prescribe exercise and bone monitoring from day one, not after a fracture. More under prostate cancer treatment in Germany.
What this is not
Hormone therapy in oncology is not hormone replacement therapy and not «hormone tablets for wellbeing»: the aim is the opposite, and confusing the two is dangerous. Women on anti-hormonal treatment for breast cancer are, as a rule, not given standard menopause preparations; their complaints are eased by non-hormonal means. Hormones in the menopause: see hormone replacement therapy.
Nor is it an alternative to chemotherapy: some patients need only hormone therapy, others need both, and the tumour board decides from the properties of the tumour, not from preference. See also chemotherapy in Germany. The current German breast cancer guideline of the medical societies bases this decision on the same properties.
Where this is done and by whom
Hormone therapy is prescribed and supervised in cancer centres, breast centres and uro-oncology departments. AlenMed’s partners include the gynaecology and gynaecological oncology clinic of the Markus Hospital in Frankfurt, headed by Prof. Marc Thill, and the gynaecology department of the Red Cross Clinic in Munich with Prof. Michael Braun and Prof. Martin Pölcher. Another partner is the urology clinic of the University Hospital Essen under Prof. Boris Hadaschik.
The team also includes the pathologist who reported the receptor status, a radiation oncologist if radiotherapy is involved, and a doctor watching bone and metabolism. Ask at the appointment who will supervise follow-up at home.
Frequently asked questions
Does hormone therapy help if the tumour has no hormone receptors?
No. If breast cancer cells have no oestrogen or progesterone receptors, hormones do not drive their growth, so cutting off access makes no sense. Treatment then relies on chemotherapy and, depending on the tumour, drugs against the HER2 protein or immunotherapy. That is why the receptor status comes first.
How long does hormone therapy last?
Usually months or years, not weeks. In hormone-dependent breast cancer, tablets are taken daily for several years, longer if the risk of recurrence is high. In prostate cancer, hormone therapy with radiotherapy runs for an agreed period; in advanced disease it is usually long-term, with no set end date.
Can hormone therapy be stopped because of side effects?
Not on your own, but do not suffer in silence either: raise hot flushes, joint pain or mood changes with the doctor. Some complaints can be eased, and in breast cancer the drug can be switched, which the German guideline names as a way to avoid stopping early.
Can hormone therapy be continued at home?
Yes, usually: the plan is made in Germany, and the tablets or injections then continue at home under a local doctor. This needs a written schedule with the drug’s name and dose, a timetable of checks such as blood tests and bone density, and translated reports.
How AlenMed arranges the treatment
First the documents: AlenMed sends the histology report with the receptor status, discharge letters and images to a specialist centre. The doctor answers whether hormone therapy is indicated, whether the material needs re-examining and what one trip can achieve. Then come a written estimate, a visa invitation, an appointment date and an interpreter for discussing the plan, since the drug is taken for years.
Before leaving, plan for enough of the drug and a clear written schedule, agreed follow-up dates, written advice on bone health and side effects, and translations for the doctor at home.
This material is for information only and is not an offer. The treatment plan is decided by a doctor in person.
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