Impact of Longterm Hormone Therapy - Emasculation

When I was diagnosed, aged 60, it became clear fairly early on that our sex life was going to be adversely impacted. Being blunt, total emasculation in my 60th year definitely wasn’t high on my agenda!

A change to my sex life

A stage 4 diagnosis can inevitably lead to a man being prescribed androgen depravation therapy (ADT). I have found very little alternative to it. You see, testosterone feeds prostate cancer, and the first port of call is to starve the cancer of food. Regrettably the side effects are devastating in many ways, but particularly as far as a man’s sexuality is concerned.

My oncologist warned me that I’d lose my libido and that erections would be highly unlikely.

Watching my manhood fade away

The treatment is effectively chemical castration, and I would also have the double whammy of being prescribed Abiraterone that stops the adrenal glands producing pseudo testosterone.

Over the months that followed, it was very sad feeling my manhood and erections fade away, and all thoughts of sex becoming none existent.

Testosterone also helps semen production, and so another byproduct would be dry orgasms. This also impacts the feeling of having your manhood removed.

Other side effects

Turning away from the sexual impact briefly, let’s consider the other side effects. Fatigue, loss of muscle mass and bone density, loss of body hair, emotions played havoc with, weight gain, hot sweats and flushes. Effectively it feels like you’ve become a menopausal woman overnight, and that simply magnifies the loss of masculinity. I knew I was in trouble when I started thinking that pastel shades seemed appropriate for clothing choices!

I truly struggled with the loss of masculinity and fading sexuality, and it had a huge impact on me mentally. I was therefore blessed to have a very supportive wife, and we discussed seeking help. Men have to remember that it’s a sign of strength to seek help, not a sign of weakness.

Talking to a therapist

We were very fortunate that my cancer unit had a Clinical Nurse Specialist (CNS) who was also a psychosexual therapist, and we were referred to her. We’ve since had several very intimate discussions with the CNS both as a couple and on my own. They proved to be incredibly helpful.

We talked very openly about sensuality and intimacy and how they now needed to play an even more important part in our relationship.

But the clincher for me was a discussion about the difference between drive and desire. The CNS told us that testosterone fueled my drive; however it does not fuel my desire. She asked “Do you still desire your wife?” Well, there’s only one answer when she’s sitting next to you but, joking apart, the answer was, yes, of course I did.

We were sent away to work on sensuality and intimacy, although we didn’t follow the instruction manual to the letter!

Maintaining some spontaneity

I also discussed with the CNS what else we could do, and she helped me to be prescribed Taladafil (Cialis) and has since helped with dosage changes to see what might work best. Taladafil works better for me than Viagra, as it helps maintain some spontaneity. Results are not totally satisfactory but help produce a modest erection, when stimulated, which is good enough for mutual masturbation, but not for penetrative sex.

I was also prescribed a vacuum pump but haven’t used that for sex, with constriction rings, as that would take away spontaneity. But I do use it to exercise the penis and maintain health/length. At the end of the day, the penis is just another muscle.

I know that I could also try Caverject injections, but I have shied away from that so far.

Working through it with my wife

The most important person in this, though, has been my wife. She’s been incredibly patient and understanding. But we have also worked together on intimacy and sensuality and have found a way to pleasure each other that doesn’t involve penetration but maintains sexuality.

From my viewpoint, reaching orgasm is challenging but achievable, and when achieved they are pretty earth-shattering. In fact, my wife is scared that one day reaching an orgasm might actually kill me!

My conclusions on this are:

• Early diagnosis can always produce a better outcome than what I’ve outlined.
• Focus on your desire for each other, and remember that the treatment may have removed your drive, but it hasn’t affected your desire.
• Work on it together as a partnership. That can produce a better outcome for both of you.