Prostate cancer and treatment with androgen deprivation therapy (ADT) affects large numbers of the male population. Endocrine effects of ADT are a critical consideration in balancing the benefits and risks of treatment on long-term survival and quality of life. This review highlights the latest advances in androgen manipulation in prostate cancer with an emphasis on muscle and bone effects of ADT which universally impact on the health and well-being of men undergoing ADT for prostate cancer. Muscle mass declines with ADT, however the evidence that this correlates with a decrease in muscle strength or a decrease in physical performance is discordant. Cortical bone decay also occurs associated with an increase in fracture risk, hence optimization of musculoskeletal health in men undergoing ADT is crucial. The role of exercise, current and emerging anabolic therapies on muscle as well as various new strategies to prevent bone loss in men undergoing ADT are discussed. Future well-designed, prospective controlled studies are required to elucidate effects of ADT on physical performance which are currently lacking, and larger randomised-controlled trials are required to test the efficacy of medical therapies and exercise interventions to target proven deficits and to ensure safety in men with prostate cancer.