Guest post 2: what can happen to sex after ADT

By Martin Wells

“No sex after ADT” – the biggest fear of many men with prostate cancer. Here’s how my sexuality adapted to Androgen Deprivation Therapy (ADT). Along the way I have learned a lot about testosterone, about relationships and about myself.

As a younger man, I thought I was in charge of being sexually available, having a hard on, wanting sex, doing really sexy crazy things. My sexuality was all about feeling very horny, wanting to shoot my load, wanting to penetrate and be penetrated, wanting to have orgasms. It felt fantastic!

Testosterone drove me

I hadn’t realised how testosterone was in charge of me. I didn’t have to do much at all – my testosterone did it for me. And I didn’t really notice my deeper need for sensuality and human connection. My sexuality kind of overtook my sensuality.

My mentors, including my parents, also had no words to describe what this might mean to me – what I now call sensuality.

Hormone suppression (ADT) took away my conventional libido

After my first post-op PSA test showed that my cancer had spread far beyond my prostate, I was put on two and a half years of Zoladex. That’s androgen deprivation therapy (ADT). Quite simply, the drugs I took removed all of my testosterone and left me without conventional libido or sexual function. I was also given what is sometimes called “salvage radiation” – five weeks of daily external beam radiation therapy (EBRT)

No more of that hot sexuality on ADT.

When my testosterone was artificially suppressed, I realised that if I worked really, really hard at it, I can still connect in a sensual way with a loving partner. But if I want the same kind of results, I really have to put some work in.

Alternative to sex after ADT: discovering sensuality

Once I was on ADT, I missed the hot sex – and yet it allowed me to explore things. God Almighty, I discovered sensuality.

I’d lost touch with my sensuality previously because of the power of my hot sexuality – and those around me. Asking me to give up that heat and lust was a bit like asking somebody to get sober while they are sitting in a pub. And the guys I was seeing back then were just into this hot-and-fast sex.

Once they’d shot their load, I couldn’t understand why they got up and left as if the house was on fire.

I wanted to say “Hullo, can we just have a bit of a cuddle?” They weren’t interested.

So when my own sexuality really died down with my testosterone suppressed, my eyes opened up to alternatives. Not only did I discover my own sensuality, but I found other people who were into sensuality and sharing that with me. It was a revelation. And this opened the pathway to my current long term relationship.

Creating new long term relationships

I am so lucky with my partner. We met after my first ADT treatment was over, during a period when I was able to be sexual in the more conventional way. And we both enjoyed that together.

But we have stayed together for 5 years, even after I was put onto a second round of ADT – this time for the remainder of my life.

I remember saying to my partner before the beginning of this second and ongoing course of hormone suppression, “It’s going to be different. And I really apologise.” He chose to stay with me, even though he couldn’t have known what it would be like. He is still full of sexual energy. He’s younger than me and definitely hasn’t lost the ability to ejaculate like I have. And we are still together now 3 years later.

What it’s like shifting to sensuality from sex after ADT

Here’s an example of how things changed when my testosterone was medically suppressed in order to slow the progression of my ongoing prostate cancer. We were in an apartment with a very small shower cubicle.

Before ADT, one of us would say “Do you want to have a shower together?” and we would eagerly squeeze in there together, and just love the close touch and the sexual energy that would generate. The joys of hot bodies together in that tiny steamy cubicle!

About three months into my hormone suppression therapy, one Sunday morning, I remember him saying “do you fancy having a shower?” and my first thought was “No, it’s too small.” The same steamy cubicle, different hormones in me. Different response.

In many ways my body just didn’t want to even try and get up close and hot and sexy together. Then I caught myself and said “Yes, let’s have a shower together.”

Sustaining conscious and intentional sensual relationship

So there we were, squeezing back into the tiny steamy cubicle, only one of us capable of conventional sexual arousal. At that moment, I realised that the sensual part of me had been switched off by the hormone suppression along with my sexuality. Previously my sensuality had simply been a natural part of me, almost like autopilot. From now on, I realised, I had to put the conscious effort in to stay connected instead of us slowly drifting apart.

My realisation and my responsibility:

“Actually I have a responsibility here as well. I’ve got no testosterone. I care about this man. What am I going to do about it?”

I made a conscious choice to say I still want to connect with this man. It won’t be as hot as before but I will still choose to say Yes to staying close and sensual. Even in a rather too-tight shower cubicle.

Long term challenges

Now, three years into my lifetime chemical castration, I see that I tend to forget about these very lessons. I need to remind myself of the choices I and my partner made, back in the apartment with the very small shower cubicle. I know the way my personal growth works, I need what I call a contract with myself to stay awake. That includes retaining my sensuality and making time to share this with my wonderful testosterone-abundant partner.

It is a story that is still unfolding. I have already outlived the lifespan of my father and grandfather. I am 67 and I am grateful …

[Editor’s note: read more about Martin’s treatment here]