GnRH Agonists (Leuprolide, Triptorelin, Goserelin)

GnRH agonists such as leuprolide, triptorelin and goserelin act by initially stimulating then desensitizing the pituitary‐gonadal axis, resulting in profound reduction of gonadal hormone production (estrogen and testosterone). For hormone therapy contexts—such as advanced prostate cancer, transgender hormone therapy, endometriosis, or other endocrine disorders—GnRH agonists provide powerful suppression of endogenous hormone production, which can then be supplemented with desired hormones (e.g., estrogen in trans women) or leveraged in other hormone-driven disease contexts. Because they are injectable (often monthly or every few months) and require monitoring of hormone levels, bone density, cardiovascular status and metabolic effects, they are higher-cost therapies and typically used in specialist care. Their use may lead to side-effects such as hot flashes, bone loss, mood changes, and cardiovascular effects. Long-term usage often necessitates bone protective measures (calcium, vitamin D, possibly bisphosphonates) and careful endocrine follow-up. Given their potency, they are a cornerstone in many advanced hormone suppression protocols.