One of the most commonly discussed adverse side affects from ADT is sexual dysfunction. Due to the decrease in testosterone, most men do experience a decrease in libido and potency.
The Prostate Cancer Outcome Study (PCOS) of the SEER program assessed the quality of life outcomes of 431 men who were on ADT (Potosky, AL, Knopf K, Clegg LX et al., “Quality of Life Outcomes After Primary Androgen Deprivation Therapy – Results from the Prostate Cancer Outcome Study”, J Clinical Oncol (2001);19, pp 3,705-3,757). Men who reported no sexual interest increased from 27.9-31.7% to 58-63.6%. Men who could not achieve an erection increased from 35-37.9% to 73.3-78.6% following ADT.
Because of the significant decrease in libido many men have no interest in pursuing medical therapy to treat their lack of potency. However, intraurethral injections of Alprostadil or the use vasoactive drugs (i.e. Viagra) and vacuum assisted erection devices have been successful for men with erectile dysfunction caused by other etiologies and so maybe successfully used by some men on ADT.
In addition, hormone manipulation may also help counter sexual dysfunction. Anti-androgen monotherapy and the implementation of an intermittent ADT schedule has been shown to restore potency for many men during the “off” period.
My personal experience with ADT is very consistent with the experiences of the men studied in the PCOS study. I started ADT2 (Casodex and Lupron) and remained on them for nine months, after which I began an “off” cycle. Currently my “off” cycle has lasted 10 months.
While on ADT, I lost all interest in any sexual behavior as well as being completely impotent. I had absolutely no interest in trying any interventions to correct the situation because I just did not care (total loss of libido). As my “off” cycle continued and my testosterone levels began to recover, my interest in sex and my ability to achieve an erection also recovered. Currently, I have an active sex life, which I am enjoying.
Unfortunately, some men do not recover their testosterone levels on their “off” period. In addition, as we progress to multiple “on and off” periods, often the rate and speed of testosterone recovery does slow down.
Joel T. Nowak MA, MSW