Loss of Libido (Reduced Sex Drive)
What causes it: Loss of libido means a lowered interest in sex. The primary cause in prostate cancer treatment is hormone therapy (ADT). ADT drastically lowers your testosterone level – the male hormone that fuels sex drive. With little or no testosterone, many men experience a significant drop in sexual desire. You simply may not think about sex as much, or you might feel “asexual.” This is a normal physical effect of low hormones. Hormone therapy medications (like LHRH agonists, GnRH antagonists, or anti-androgen pills) all contribute to this because they either stop the production of testosterone or block its action. Surgical castration (orchidectomy), which permanently removes the testes, also causes permanent loss of libido, since the body can no longer produce testosterone. In addition, the emotional aspects of a cancer diagnosis and treatment side effects like fatigue or depression can dampen sex drive.
How it affects daily life: A reduced sex drive can lead to strain or confusion in your intimate relationships. You may not initiate sex with your partner, or you might feel indifferent when previously you had a healthy interest in sexual activity. Some men say they miss having sexual thoughts or fantasies – it can feel like a part of their identity is diminished. You might also feel less masculine or have lower self-confidence. In practical terms, you could find that you rarely get erections (even nighttime or spontaneous erections decrease) because libido and erections are closely linked. This side effect can last as long as you are on hormone therapy; if therapy is stopped, testosterone will slowly return and libido may improve over several months to a year. However, not everyone’s sex drive returns fully, especially if you’ve been on long-term hormone therapy.
Ways to manage or reduce it: There is no guaranteed way to restore libido while on hormone therapy, because the underlying cause is the low hormone level. However, there are ways to cope. First, understand that this is a physical side effect of treatment – it’s not your fault, nor a reflection of your attraction to your partner. Explaining this to your partner can help them understand what you’re going through. If you are on long-term ADT, talk to your doctor about possibly using intermittent hormone therapy (taking breaks from treatment) – during off-treatment periods, testosterone may recover somewhat and interest in sex can return for a while (this approach is only possible in certain cases and must be guided by your doctor). Even with low libido, you can maintain intimacy in non-sexual ways: cuddling, massage, and spending quality time together. Some men also explore other forms of sexual stimulation that don’t rely on a strong sex drive, such as using erotic media or engaging in sexual activity as a scheduled “date” rather than waiting for spontaneous desire. Counseling or sex therapy can be beneficial for you and your partner to navigate these changes. If hormone therapy is short-term, remember that libido often gradually comes back after treatment is over– it may take several months, so patience is key. In some cases, your doctor might prescribe a low dose of certain medications (for example, low-dose testosterone therapy) to improve libido only if your cancer is very well controlled and after careful consideration of risks – this is rare and only in special circumstances. Overall, focusing on emotional intimacy and remembering that closeness isn’t solely dependent on sexual intercourse can help you maintain a fulfilling relationship until your sex drive returns.