Navigating sex after hormone therapy for prostate cancer

Close up of two men holding hands

There are lots of ways to treat prostate cancer, one of which is hormone therapy, also called androgen deprivation therapy (ADT). Hormone therapy works by blocking testosterone (because testosterone can help cancer grow). During and after hormone therapy you should expect some changes in your sex life. These changes can affect your body, mind, and relationships because sexuality is not only physical, it includes your thoughts and feelings too. Although hormone treatment does affect sexual function, there are ways to ensure you still enjoy a healthy, happy sex life.

Hormone therapy for prostate cancer compared to other treatments

Hormone treatment, radiation therapy, and chemotherapy are three distinct approaches to treating cancer, each with its own process and side effects.

  • Hormone treatment for prostate cancer, also called androgen deprivation therapy (ADT), lowers testosterone levels to slow cancer growth, potentially impacting sexual function.

  • Radiation therapy uses high-energy rays or particles to target and destroy cancer cells, typically causing fatigue and side effects in the treated area, such as skin irritation.

  • Chemotherapy involves using powerful drugs to kill cancer cells throughout the body, often causing systemic side effects like hair loss, nausea, and a weakened immune system.

While each treatment has its own unique set of benefits and drawbacks, the type of therapy depends on factors like cancer type, stage, and your overall health. Some people experience multiple therapies.

Side effects of hormone therapy for prostate cancer

What to expect and how to cope with changes in genital size

We know it's a sensitive topic, but it's important to talk about the connection between hormone therapy for prostate cancer and changes in genital size.

By reducing testosterone, you may notice your testicles or penis getting smaller. Sometimes the penis can shorten because of the lower levels of male hormones caused by hormone therapy. This can be upsetting. It’s important to remember size isn’t everything and you can still get and give pleasure no matter your size. Find out more about penis shrinkage after prostate cancer treatment and how to reduce it.

If your confidence is being affected, try speaking to a sex therapist and remember to keep an open dialogue with your partner.

"My partner kept reassuring me that it doesn’t matter but it did to me. I did try the pump. My penis felt cold and strange, but it did help."

Gary, 69 years

Hormone therapy and erectile dysfunction (ED)

Because of the way hormone therapy affects your body, many men experience difficulties with their erections. Navigating the impact of erectile dysfunction can be challenging.

Timing of erectile dysfunction after hormone therapy

Many men usually experience problems with their erections within six weeks of starting treatment. If your hormone therapy is short-term, you may see the recovery of erections about six months after stopping treatment. If you have to stay on hormone therapy long-term, difficulty getting an erection may be permanent. You can still maintain a satisfying sex life through:

"The gradual change to my erections was strange, I feel less like wanting sex now but I know I will be finished with this hormonal treatment soon and I use the pump to give my penis some exercise. It might be a waste of time but I feel I’m doing something."

Gary, 69 years

Difficulty reaching orgasm and hormone therapy

Reaching the big O can be a bit more challenging during hormone therapy for prostate cancer. This is because low testosterone can make it harder for some men to finish. You may also notice that when you do get there, less semen comes out or that it feels less intense or different than before. This is totally normal and not something to worry about.

"For months I thought my sex life was over and I would never orgasm again. I was playing around in the shower and low and behold ACTION! It was an incredible feeling."

Iain, 48 years

Bodily changes

Changes like weight gain, breast swelling and hot flashes (hot flushes) are common side-effects of hormone therapy. There are things that can help with hot flashes such as wearing loose cotton clothing and reducing alcohol. Being patient with yourself is also important if you do gain weight, as it may take a while to lose the extra weight. Staying physically active can help your physical and mental health during this time. Find out more about the impacts of hormone therapy.

"With all the changes to your body, breast growth seems like a small thing to worry about, but it is so uncomfortable. It helped when I had some daily exercise."

Trevor, 68 years

Fatigue, even after rest

Hormone therapy is likely to cause tiredness. Fatigue can come on quite suddenly and can affect your energy levels, motivation, and emotions.

There are things you can do to help fatigue during hormone therapy and its impacts on your sex life. This includes:

  • Planning your sexual activities ahead, in a part of the day when you have more energy.

  • Regular exercise because research shows that this can help with fatigue even if you feel tired.

  • Remembering that tiredness is normal during hormone therapy for prostate cancer and will ease after treatment stops.

"My energy levels go up and down, but I try and take things slowly, and take advantage of the times I feel like I have more energy. We now have cuddles in the bed in the morning."

Patrick, 72 years

Managing emotions, like anger and fear

It's completely natural for you to experience a range of emotions, including fear, anxiety, and even grief while going through cancer treatment. Of course, all these feelings can get in the way of your sex life and cause stress in a relationship.

How to cope with the emotional impact of prostate cancer treatment

  • Foster open communication.

  • Focus on non-sexual intimacy (like spending time together, doing the things you love).

  • Be patient.

  • Educate yourself and your partner.

  • Connect with others who’ve had prostate cancer.

  • Seek professional support, like a counselor or therapist.

Impact of hormone therapy on desire and sensitivity

Desire is the initial spark that starts the sexual response cycle. It's when we think about sex, fantasize about sexual situations, and begin to imagine making them happen. Many men may experience a lower sex drive (desire) during and after hormone therapy and that spark may be harder to ignite.

If hormone treatment is temporary, your sex drive could return about six months after stopping treatment. However, for some men, their sex drive may remain lower even after stopping hormone therapy.

After hormone treatment for prostate cancer, you might feel less sensitivity in your penis, requiring longer stimulation. You may need to wait longer before you can reach orgasm again, but the relaxation and pleasure after orgasm will still be present.

Coping with sexual changes

As you face the challenges of hormone therapy for prostate cancer, remember that you're not alone. With the right information, support, and resources, you can maintain a fulfilling and satisfying sex life. Keep the conversation going and stay connected with your partner and healthcare team to navigate this journey together.

Your doctor can also refer you to a sexual health counselor or sex therapist who can provide some helpful guidance.

Many individuals say that after having prostate cancer and treatment, they initially struggled with sexual changes. And after working through these changes, although their sex life is different, they now feel satisfied with their ‘new’ sex life.