Having hormone therapy affects your sex life in different ways.
- It changes your desire for sex (libido) and may mean you have much less interest in sex.
- It can cause problems getting and keeping an erection (erectile dysfunction).
In most cases, these effects last for as long as you are on hormone therapy. It can take up to a year for sexual function to gradually return to normal after stopping hormone therapy. Very occasionally, some men don’t see an improvement after stopping hormone therapy. If you’ve had surgery to remove the testicles (orchidectomy), these side effects can’t be reversed.
Desire for sex (libido)
All types of hormone therapy will change your sex drive and may mean you have less interest in sex. This is because hormone therapy lowers your level of testosterone, which is what gives you your sex drive.
Testosterone is not the only thing that can affect your sex drive. Other physical and emotional factors can also affect how you feel about sex.
- Some men describe feeling like they have lost their self-esteem and confidence, particularly around their masculinity.
- If you are feeling depressed or anxious then you may be less interested in sex.
- Treatment can cause tiredness and mean you have no energy for sex.
- You might feel worried or embarrassed about physical changes after hormone therapy – such as putting on weight, changes to the size of your penis or breast swelling.
If you have a partner, their desire for sex might also change after your diagnosis and during treatment. If they are feeling anxious, they may have less interest in sex. Dealing with a cancer diagnosis and treatment can also put a strain on relationships – this can affect how you and your partner feel about sex.
All types of hormone therapy can cause problems getting or keeping an erection (erectile dysfunction or ED). Having less interest in sex can also play a part.
Anti-androgen tablets are less likely to cause erection problems than other types of hormone therapy. But if you have advanced prostate cancer, anti-androgens taken on their own are not as effective at controlling the cancer as other types of hormone therapy.
What can help?
Men with prostate cancer can get free medical treatment for problems with erections or other sexual problems on the NHS. Your GP or doctor or nurse at the hospital can prescribe treatment. Treatments are available to you whether you’re single or in a relationship. You can also be referred to a specialist service such as an erectile dysfunction (ED) clinic.
There are different treatments for erection problems available. Your doctor may first suggest you try tablets that belong to a group of medicines called PDE5 inhibitors (for example Viagra). Tablets, such as Viagra might not work for everyone, especially if your hormone therapy is affecting your desire for sex. But there are many other treatments that can help give you an erection without sexual desire.
Try not to be embarrassed to go and talk to your doctor or nurse. Remember that they will have talked about these problems many times before. As well as discussing the treatments available, they can also let you know about local support groups or counselling services available in your area.
If you are finding it difficult to deal with losing your desire for sex or problems with erections, intermittent hormone therapy might be an option. This involves stopping treatment when your PSA level is low and stable, and starting treatment again when your PSA starts to rise. Your sexual function may improve during your break from treatment. Speak to your doctor about this.
Changes to ejaculation and orgasm
You may notice that you produce less semen while you are on hormone therapy. You will still have feeling in your penis and you should still be able to have an orgasm, but it might feel different to before treatment. Some men have less intense orgasms when they are having hormone therapy.
Changes in penis and testicle size
Hormone therapy can make your penis shorter.It can also make your testicles smaller. Treatments for erection problems, such as using a vacuum pump, might help to keep the penis tissue healthy and in good working order, but more research is needed into this.
If you put on weight because of your hormone therapy, you might find it harder to see your penis. This could mean that you don’t aim so well when urinating. Problems with aim, or a smaller penis, mean that some men prefer to sit rather than stand when they urinate.
Dealing with these changes
Men deal with changes to their sexual function in different ways. Some men find that because they no longer have a desire for sex, it’s easier for them to come to terms with problems getting an erection. But for others, these changes can be a big loss.
If you have a partner, talking about sex, your thoughts and feelings can help you both deal with any changes. It is not always easy to talk about sex and relationships, even for a couple who have been together a long time. But it can bring you closer together and make you feel more confident about facing changes and challenges.
If you are finding it difficult to talk about sex, it might help to see a sex therapist (a psycho-sexual counsellor). They help people who are having sexual problems or experiencing difficulties in their sexual relationship. Your GP, doctor or nurse may be able to refer you to a sex therapist, but this type of therapy is not always available on the NHS. You can find a therapist yourself by contacting the College of Sexual and Relationship Therapists. The organisation Relate provides relationship counselling and other support services.
Remember – having sex is not just about erections or penetrative sex. Men can have orgasms without an erection or ejaculating and some men get pleasure from pleasuring their partner. There’s no one way to have sex or experience sexual pleasure – have fun and experiment.
There are also other, non-sexual ways of being close. This can be as simple as holding hands or trying new activities together.
Yes we still have sex, but in different ways and with a little bit of medical intervention.