We went through something quite similar with my partner after about a year on ADT — the fatigue and low haemoglobin really crept up on him, and it honestly became harder to deal with than the cancer itself. His kidney numbers dipped at one point too, which really scared us, but in his case they improved again after closer monitoring and a medication review (they adjusted a couple of other drugs he was on, which seemed to help).
One thing we learned the hard way is that it’s not always just the ADT in isolation — it can be the combination of ADT, age, hydration, and other meds all interacting. That said, his oncologist did acknowledge that long-term ADT can put strain on the body in different ways, including anaemia and possibly kidney function.
If your husband is already this wiped out and needing transfusions, I’d definitely be pushing for a really frank conversation before that next injection — quality of life matters too, not just the PSA number. We were told something similar to the reply above, that most of the benefit is upfront around radiotherapy.
The kidney pain is the bit I’d keep flagging though — even if scans were clear, pain usually means something needs another look, even if it turns out to be something less serious like muscle or referred pain.
You’re absolutely right about not letting it drag you into a dark place — but also don’t be afraid to push the doctors a bit when things don’t feel right.