A man looks up at a testosterone molecule.

Testosterone Is Vastly Underrated!

Everyone needs testosterone to drive performance whether that be athletic or sexual. Caster Semenya the South African athlete was told that she needed to take medication to reduce her testosterone level if she wanted to be able to compete internationally. Although testosterone is a male hormone it is needed by women as well but what does it do for us men?

Testosterone serves a number of purposes

It’s been described to me as providing our drive. The drive to get out of bed in the morning, our athletic drive, and our sex drive. It also builds muscle mass, increases bone density, impacts on our body hair production, produces sperm, and helps us metabolize fat.

What many people don’t know, however, is that, regrettably, it also feeds prostate cancer! The main source of men’s testosterone is the testicles but other glands, such as the adrenal glands, also produce it.

How does testosterone play into treatment?

Treatment for lots of men diagnosed with prostate cancer, particularly advanced stage, has historically been to remove testosterone via Androgen Deprivation Therapy (ADT), and this has a massive impact on men’s lives.

When I was diagnosed with advanced-stage prostate cancer in May 2017 I was told that I would be put on ADT immediately and I’ve had 3 monthly injections ever since. I was also due to have chemotherapy in August 2017.

Coping using humour

My oncologist is a straight-talker but also very empathetic and I like that combination. I’m reminded of our conversation with him about starting ADT when he explained the impact by saying, "Regrettably, once you start on this treatment you’ll be unable to get an erection but it probably won’t matter as you’ll not want one due to loss of libido."

When I asked if there was any other bad news to come he said, "Yes, you’ll experience penile shrinkage so use it or lose it!" Of course, this is an embellishment of that conversation but it’s also indicative of how my wife and I try to meet the issues with humor.

In fact, the other day she asked me to put some music on so I asked her what she’d like and she said, "I’d love a bit of sax." Well, I nearly wet myself.

Seeking help is a sign of strength

Despite the humorous way in which we cope with this there is a serious side to the impact on men’s sexual performance. I’ve been very lucky to have the support of a psychosexual therapist and she explained to my wife and me that whilst the treatment would remove my sex drive it wouldn’t remove my desire. We’ve clung to those words ever since to help us maintain intimacy.

Unfortunately, I’ll never have a strong enough erection to have penetrative sex again, even with chemical support from those little blue, or in my case, yellow pills. This doesn’t stop us enjoying intimacy though and enjoying each other’s bodies and I am able to still reach orgasm on most occasions and its mind-blowingly intense. My wife worries that it might kill me but I reckon the cancer will get there first! We’ve found that, by using sex toys, we can still find ways to pleasure each other. It’s not the same but it beats the alternative!

As for the oncologist's words “use it or lose it” I have been prescribed a vacuum pump. I find it a bit demeaning to use it but I think of it as just another muscle that needs exercising and we all know how important exercise is for those living with and beyond cancer.

Work together as a partnership

The point of this article is that the impact on men of ADT, and other prostate cancer treatments, massively impacts relationships but, working as a partnership, that impact can be lessened.

It’s important to know that there is professional help out there. Men shouldn’t be afraid of seeking that help but do need to include their other half’s. There’s little point having those discussions in isolation from your partner.

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