ADT, Libido, and Puberty
Last updated: March 2023
There is quite a lot in living with treatment for prostate cancer that I never heard about from my medical providers. I had to sort it out for myself along the way. Many of my experiences with androgen deprivation therapy (ADT) are humorous when seen in the rear view mirror, though they may not have been at the time.
ADT's impact on my libido
The first experience was dealing with the effect of hormone treatment on libido. I knew that once the meds kicked in, I would have no libido. No sex drive. I had heard that there is often a flash of testosterone in the first weeks before testosterone is shut down, but could not visualize what this flash of testosterone might feel like.
One day at the market I realized I was openly ogling women! I'm normally too shy to give more than a furtive glance at most, but now I found myself taking an unusual interest.
At first I felt embarrassed, then I saw humor in my situation and had to laugh. I wondered what the ladies would think if they knew they were attractive enough to get a castrate man's attention.
After a bit it dawned on me that this was the testosterone flash. A few days later the libido took an obvious dive.
Trying to produce a high-quality erection
With my wife's support I went on a regimen of producing at least one high-quality erection each day to help stave off penile atrophy. Having no libido or interest in sex made this an interesting project and made for quality intimate time with my wife. For the most part this routine became habit, though my wife did have to remind me once or twice.
One gent had mentioned that he felt more relaxed in not having to deal with libido. I thought this was heresy, but then gave it more thought. I have a very strong sense of modesty and have always been extremely uncomfortable with physical exams that included genital exams and digital rectal exams (DRE). Or maybe terrified would be more accurate.
I decided that having no libido while folks were busying themselves poking at my groin would free me of anxiety in dealing with my sense of modesty. I could relax. I welcomed that thought.
Feeling anxious about arousal during exams
I had reason to be anxious, as I had once become aroused during an exam for testicular cancer. I felt humiliated at the time and determined I would never find myself in that situation again.
That hope was short-lived. During the pre-treatment simulation, the young lady who did the targeting tattoo for the alignment lasers pushed the modesty blanket further down without warning. I was surprised to feel the same reaction I would if I'd had libido.
I wrote a note to the supervisor telling her that the technicians needed to ask me to make any necessary adjustments in clothing and blanket, and to keep me advised of what they were doing. During actual treatment sessions they were pretty good about humoring me.
Seeing my testosterone return after ADT
Within three months after I completed ADT, my testosterone was returning. One day I noticed a slightly sensitive lump in my left nipple. I had vague memories of having sensitive breasts when I was going through puberty, but breast cancer also came to mind.
I decided to check with my physician just to make sure. He checked the lump and set me up for a mammogram.
When I told my wife I was to have a mammogram, she shared dark stories of having her breasts crushed between two plates. Whooopie! Well, I thought, at least it could not be as bad as a biopsy.
Actually, it turned out to be fairly painless. The young lady doing the mammograms had a very caring, professional and friendly nature that made the procedure go smoothly. I was amazed that she was able to find enough of my chest to fit between the plates.
Lumps typical of puberty
When the radiologist sat down with me to go over the results, he verified that I just had lumps typical of puberty. I nearly came unglued with relief that I wasn't facing yet another cancer.
Going through a second puberty was quite a surprise, but it made sense. Puberty is the onset of testosterone and other hormones, just as getting off ADT was allowing me to begin again to produce testosterone. I wondered whether my medical providers are aware of this.
Now over two years after the end of treatment, recovery from ADT appears to be an ongoing journey. I'm curious what other surprises are in store.
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