Jerry, orchietomy, that I believe you are referring, has the same side effects and increased risk of MACE. Physical castration and chemical castration both nearly eliminate testosterone. The side effects of hot flashes, weight gain etc are from the low or no T and not the method that gets it there.
Sure, generally agree, most side effects are from no T. But all drugs do
have side effects and varying effectiveness, and notable they do
have to be administered. Daily pill, monthly shot, multi-monthly shot, whatever, there is cost and risk. A surgery has its own risks, but it is a one-and-done effort, one cost.
The cardiac issues around ADT are a rather complex topic. I'm probably misunderstanding the comment, but it seems to imply that orchiectomy has cardiac risk and the drug therapies don't. Notably some ideas like estrogen monotherapy were tagged with this, but mainly due to the way
it was done in early studies. It's just not simple to evaluate these things.
For what it's worth, this study from 2015 discusses a LOT of factors around various forms of ADT: Cardiovascular effects of hormone therapy for prostate cancer