 Moreover, monotherapy is overall better tolerated and associated with greater quality of life than is castration, which is thought to be related to the fact that testosterone levels do not decrease with monotherapy and hence by extension that levels of biologically active and beneficial metabolites of testosterone such as estrogens and neurosteroids are preserved.For these reasons, monotherapy has become an important alternative to castration and in the treatment of prostate cancer.Bicalutamide may be used to reduce the effects of the testosterone flare at the initiation of agonist therapy.