Zero Libido

By Alfred Samuels

2 min read

As a person goes through a cancer journey, any long-term relationship can experience fluctuations in intimacy and desire. Causes of decreased desire can vary from emotional issues to hormonal shifts to stress. Many people are horrified at the thought of the loss of libido. But I feel that men on androgen deprivation therapy (ADT) may not always notice it is happening at first.

Less desire for sex

When I was diagnosed with advanced prostate cancer, little did I know what lay in wait. It is also known as androgen suppression therapy, which is an anti-hormone therapy whose primary purpose is to treat prostate cancer.

It's only after a while that you realize that, although your nude partner still looks seductive, you just aren't interested in anything further. For me, it's not that difficult, but it can be very hard (excuse the pun) for her to feel that she is no longer desirable physically. Lacking desire does not mean you can't still give pleasure.

It simply implies that you should schedule some time to provide your partner with some of what they require (tender, loving care). If not, you may easily reach a situation where you feel like roommates.

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After ADT, kissing my wife didn't feel the same

I originally had twelve months of ADT, which lasted about two years until my T therapy started to recover. By the end of that, kissing my wife felt like kissing my sister, and I found that quite sad and repulsive. It is easy, though, to fall into self-pity rather than appreciate what the other partner's perspective must be like.

I found it most difficult to comprehend and navigate this region. There was an inclination to agree while speaking with other men. I have not been able to regain normality during the past 12 years. Since my wife and I have talked about it, I know there is a feeling of betrayal. What I wouldn't do to regain our intimacy, like we had once before.

But the love of my life will still be my love

Unfortunately, while graded with advanced prostate cancer, it means I will be on ADT for life. However, I know this does not mean I can continue to ignore my wife. I'll have to maintain our relationship as a genuine partnership by staying self-centred.

The love of my life will still be my love. Lack of lust is merely the absence of becoming "horny." Hugs, kisses, and love will remain as important as ever, and maybe even more so. Losing interest in sex alone does not equate to losing interest in intimacy or emotional attachment.

Sex is not all there is

Unknown to me, hormone therapy has been the reason for my depression at times. Prostate cancer hormone therapy has caused issues with my thinking, focus, and memory. Talking with my doctor was not the best avenue to venture. Only a real specialist was able to help, as I found out. I promise you that a consultant with this kind of training is invaluable.

But, as my wife has always maintained, sex is not all there is to a relationship or marriage. In my mind, my wife is beautiful now and will always remain beautiful. It just takes more work. Will it be successful? I hope so.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The ProstateCancer.net team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

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Guy Meredith Moderator & Contributor
 I feel terrible for men who go through this and for their partners. It's way too common. Hormone therapy puts us into male menopause (andropause) with all the ills of female menopause; lack of libido, hot flushes, fatigue, over the top emotions/depression (mood swings), fat to the breasts and belly, loss of muscle mass and loss of bone density and so on. My hot button is to let men know that it is possible to be sexually active while on hormone treatment. I suspect, though, that to maintain sexual health this needs to begin early on during treatment. I was sexually active on a daily basis the entire 6 months I was on ADT. I'm tempted to write a "sex manual" for men without libido. Unfortunately the medical community is ignorant of this and so does not help men get there. Law enforcement is aware that men who have chosen castration over jail time for violent sex crimes continue to commit these crimes after castration. Without libido, sexual arousal comes from self motivation. Or help from a loved one. Before I went on ADT I spoke with a couple of men who had found themselves becoming aroused and having intercourse when trying to pleasure their partner despite their own lack of drive. Guy B. Meredith, moderator and cancer survivor.
bvjarvis1 Member
Having heard in a PCRI Conference presentation that resistance-training helps to minimize many of the possible side effects of hormone therapy, I ramped up my strength-training program prior to my first injection. As a result, my side-effects from Eligard were minimal - just minor “warm” flashes and muscle atrophy (resulting in about a 30% loss of strength). I did have a loss of libido, but no ED. No mood swings, emotions, fatigue, forgetfulness, confusion, memory loss, insomnia, night sweats, weight gain, etc., things (“male menopausal”) that are typically mentioned. As for the loss of libido (with my testosterone level dropping to 3.0 ng/dL), everything still worked. (I was not going to take this lying down, if you’ll pardon the pun.) So, that loss of libido did not prevent me from maintaining the physical relationship with my wife. There was no desire, but I went through the motions anyway. Sometimes you simply do what you have to do. Life is that way sometimes…… I recall telling my wife (about 6 months after my 2nd (& final) 3-month Eligard injection), that I thought the Eligard was wearing off because I was beginning to lift heavier weights at the gym. Since I wasn’t due for another “official” bloodwork for another couple of months, I self-ordered another PSA & testosterone test (out of curiosity), and those came back as 0.13 & 403.0, respectively - meaning that everything was going exactly as expected (that is, testosterone increasing on schedule & PSA staying low). Those numbers were very re-assuring to see. The libido, muscle mass, and strength all returned, and the mild “warm” flashes subsided. The relationship survived without issues. I simply had to lift some weights and push through it. Now with 20/20 hindsight, my Eligard experience was just a mild annoyance. Just as was presented in the PCRI Conference presentation, intense resistance-training was the key.
Jim Early Moderator & Contributor
This is an important article. Most of us with either initial need for ADT or on ADT with recurrence, the issues of impotence and loss of libido are critical to address. I know from dozens of discussions in our support group and from personal experience that there are endless ways men experience the side effects of ADT treatment. If erections were fairly hearty before ADT, it is likely that they can be achieved if adequately stimulated. However, to achieve an erection when your libido has been zapped is both challenging and often disheartening. If, when you start ADT, you are in a sexually active relationship and find your partner warm and attractive regardless of the profound loss of libido, you are blessed. Part of intimacy is wanting to please your partner, part of intimacy is simply the need for human contact, part of intimacy is wrapped up in our self image and part of intimacy is achieving the intensity of the climax. If you can understand the benefits of all degrees of intimacy you may be more able to overcome the expected disappointment of losing that easy emotional trigger that your libido used to provide. My advice is to try to explore all the areas of intimacy I mentioned and to do your best to relax your expectations and not ignore all the many benefits that all forms of intimacy provide. Any effort you put into this challenge can help you avoid the disappointment and even depression that this disease and ADT can trigger.
Tigershark54 Member
My wife and I have talked about this. She, on her part, has gone through menopause and her desires have also diminished. But that does not mean I don't still tell her how desirable she is to me or tease her lovingly about her curves still doing it for me. I love to see her smile and feel her warmth after a warm shower. I try and rise to the occasion mentally even though I can't physically. I like to take time to let her know she is the only one that makes my heart race. I haven't been on androgen deprivation as long as some but it along with the removal of my prostate has caused irreversible consequences to my love life. But I have tried hard to make sure that my wife knows I still find her so desirable. 
1. JillBrodie Community Admin
 Hi <inline-mention username="Tigershark54" user-id="4732087"/> it sounds like you have found ways to keep the intimacy alive. As life changes, it is so important to express our love for our partners with our words and any other ways that show affection. Thank you for sharing with us. Jill, <a href='https://prostatecancer.net' target='_blank'>prostatecancer.net</a> team
Sue Franke Moderator & Contributor
<inline-mention username="Alfred Samuels" user-id="6921303"/> Hi Alfred. You're wife is correct in that sex is not all there is to a marriage relationship. My husband had his radical prostatectomy 15 years ago and yet we still share our love and compassion in so many other ways. Most of all, I'm grateful to have him still in my life and I think your wife probably feels the same way. That's what's of utmost importance. All the best to you and Mrs. Samuels.
CommunityMember70ffeb Member
I'm 68 and had the radical prostatectomy 2 years ago, then a few months of radiation and Eligard. Still on Eligard one year now with another year to go. If I had known what I know now, I might have just stopped after the prostatectomy because my erections were still firm and brother, the orgasm from shooting blanks were unlike anything I ever experienced before. But that's neither here nor there now and I pray daily that after this second year of hormone therapy, I might become a man again. I've had depression. I've been in tears more than once. And you know, something no one has ever mentioned in any of the posts I've read from others going through this is the fact that not only do you lose desire, but you also lose quite a bit of size too! Or am I the only one? It's just downright embarrassing now to be naked in front of the love of my life, and heaven forbid I go to the showers in the gym without covering up. Sometimes I feel like this is never going to end.
CommunityMemberb2cbd4 Member
 I was diagnosed stage four and I have been on androgen deprivation therapy in one form or another for most of the last 18 years. I will say that my loss of libido was much harder on my wife than it was for myself I mean, truthfully I just didn’t care anymore. My wife however did. It was the source of considerable friction in our lives. It took 10 years to figure it out. It took 10 years to realize that I was more to my wife than sex. This created a bond between she and I based on mutual love and respect. In many ways I’m told I begin to approach lovemaking From a different perspective. I began to focus on emotional love rather than physical love, and somehow, in the midst of this, I slowly began to regain function. My wife and I share intimacy once or twice a month, and I have not used anything in the way of E. D. Medication in over six years. I guess maybe I actually got in touch with my feminine side .
Jobbers Member
Thank you for this article its heartening to know others face similar challenges. Whilst im only on Active Surveillance (since Oct 2022) my "apparatus" doesnt seem to work as well as it used to. ED as well as poor pressure and delivery of seamen are most noticable. This article will help both me and my wife.
Cierra58 Member
 I have Stage 4B prostate cancer, and I have been on androgen deprivation therapy, Orgovix for almost 8 months. After finishing chemo (Taxotere) about a month ago, Xtandi was added to the Orgovix as my maintenance treatment. The Orgovix alone didn't seem to completely kill my libido but weakening it. And after the first chemo treatment, my libido was gone, and I no longer got erections. I called my urologists and asked his nurse if I could get on an ED pill. The next day, a prescription for Cialis for daily use was called into my pharmacy. I've been on that ever since and have better erections than before this all started. I have no libido and eventually lost the ability to ejaculate during orgasm. But when ejaculation ended, so did the pain I was experiencing during orgasm. I believe sex and desire are very important for a relationship. So I simply continue to go through the motions. I do still have desire for my wife, but kissing, touching and all the rest feel different now, as others have mentioned. But somehow, this physical contact with my wife still gets my "motor running" and I can perform and reach orgasm about 9 out of 10 times. There is just no ejaculate now. Since I will always be on ADT, I plan to just keep going through the motions because I believe it is very important to our relationship. It just takes more discipline, concentration and will-power now. But that's okay. It's a very workable solution, and I hope this paradigm continues unless something better happens. 
1. JillBrodie Community Admin
 <inline-mention username="Cierra58" user-id="8662387"/> thanks so much for sharing. I am so glad to hear that you and your wife support each other. And as you said it may be different, but it works. Jill, <a href='https://prostatecancer.net' target='_blank'>prostatecancer.net</a> team 
2. Jim Early Moderator & Contributor
 <inline-mention username="Cierra58" user-id="8662387"/> Part of the issue can be the feeling of being a different person when on therapy. Libido is physiological and emotional and I've found that the libido can be stimulated or suppressed even when there are significant physical changes in our ability to achieve erection. Every relationship is different and while some may rely heavily on our sexual performance, others may thrive even more through the sharing of the struggle. The ability to fully communicate our feelings of love and affection is, to some degree, a learned behavior. If sex before the cancer was primarily a release mechanism then there will be a lot of work to fully realize the needed communication, empathy and the desire to embrace each other in a deep and meaningful way. For most of us, cancer does change our relationships and it is up to us to find out if we can create something that works for us!