Replacement Therapy, Cialis, Penile Atrophy, TRT, &

Save Your Sex Life After #ProstateCancer Treatment | John Mulhall, MD • Save Your Sex Life Aft...
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0:30 What is hormone therapy and what are the side effects usually associated with it?
2:43 How can a loss of libido affect a prostate cancer patient?
4:10 How advisable is it for patients to use Viagra or Cialis after hormone therapy?
5:38 What is the recommended dosage for a drug like Viagra or Cialis?
6:55 How long does it take testosterone to recover following hormone therapy?
8:35 How long does it take testosterone to recover following Lupron?
9:53 Do different generations of hormone therapy have different testosterone recovery periods?
11:07 How long does it take testosterone to recover following longer course of hormone therapy?
12:04 How is testosterone recovery usually monitored?
13:48 Can testosterone replacement therapy cause cancer to grow?
16:00 When should a patient start receiving testosterone artificially after treatment?
18:08 What are types and dosages of testosterone replacement therapies?
19:00 Are there any side effects associated with testosterone replacement therapy?
20:17 How should patients and caregivers approach the return of libido?
22:34 Alex's conclusions
23:33 If you would like more information
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The Prostate Cancer Research Institute (PCRI) is a 501(c)(3) not-for-profit organization that is dedicated to helping you research your treatment options. We understand that you have many questions, and we can help you find the answers that are specific to your case. All of our resources are designed by a multidisciplinary team of advocates and expert physicians for patients. We believe that by educating yourself about the disease, you will have more productive interactions with your medical professionals and receive better-individualized care. Feel free to explore our website at pcri.org or contact our free helpline with any questions that you have at pcri.org/helpline. Our Federal Tax ID # is 95-4617875 and qualifies for maximum charitable gift deductions by individual donors.

[@grahamoldfield3871]

Ive got to say having a PSA of 29 , and a Gleeson score of 9.95 is bad enough . But when found the cancer had spread to my spin and lung ( on top of scar tissue from other cancer ) . The treatment was very limited as I have had stage 4 Melanoma cancer for 17 years and Brain tutors etc for 6 years . This along with AF and associated damage from cancer treatment over the years has made life hard . The lack of testorone and sex drive along with muscle wasting has been devastating to me .I look forward to getting off treatment and getting some testorone treatment which may help with my quality of life , because quite frankly life really sucks at times so your mental wellbeing suffers . These Videos are extremely helpful .

[@Muhamedim]

@@grahamoldfield3871 wishing you all the best. By the way, PCRI has some recommended simple exercices to stop muscle waisting. Cheers,

[@gtrgenie]

Gleason 9 PSA 57.9 on 1/15/24 PSA now .157 as of 3/28/24 after Lupron 3mnth and Casodex 50mg !!!!!!!!!!!!! Radiation next These videos are a Godsend. Thank you🙏🏽

[@joemaxwell1044]

Diagnosed in March '24 Gleason 9, high pSA Hormones start in a week and I guess radiation to follow although my urologist is pressing the surgery. I dont know how old you are but im 68 and not looking forward to the miserable rest of my life. If I was younger, I might consider surgery but I simply do not wish to go through it.

[@gtrgenie]

I’m 57 diagnosed Nov 23. It took 75 days to bring down my PSA. 3T MRI April 5th to get new prostate baseline. The hormone therapy sucks for me, but it seems to be working. Good luck and exercise to reduce side effects.

[@brucemcclelland904]

This is a perfect conversation for someone like me: 18 mos. Lupron + a few months Xtandi following IMRT, 74 years old, healthy, previously high libido. My radiation oncologist thinks I’m a good candidate for testosterone replacement therapy, while my older-fashioned urologist thinks, “why risk it?”. This video convinces me that there’s no harm in seeing whether adding testosterone back into my “diet” will make a noticeable change in my QOL. I did not entirely lose my libido, but there would be advantages to having higher T, including reversing muscle loss. Thank you for this discussion.

[@TERRY-cb2ku]

Excellent comment.

[@commonsenseisdead]

Bruce, I'm 66 y/o and recently diagnosed, Gleason 3+4 (with only 10% of 4 found in only 1 of 12 cores. Around 6 years ago I had a declining libido; loss of interest, fatigue, mild depression, and loss of muscle mass. Tests revealed low T about 270. So I started TRT and can I can tell you that the boost in my QOL was immediate; like day and night. I was using one: 1% / 5 GR gel pack, 3 - 4 times a week to sort of mitigate potential risks of using Test. I also have a family history of 3 men with prostate cancer so it's debatable whether TRT had any notable impact in my cancer diagnosis. . . I have been off TRT since early December, a recent testosterone score was 183 / Free Test 1.9 and the decline in libido, energy, muscle mass, mood are back. I'm opting for 'active monitoring' for now and given my low T result I asked my young but older-fashioned urologist "would a low diet of TRT be OK under my circumstances?" He doesn't think so but I tend to disagree. Hope this helps.... FR

[@peterriley2022]

I am 66 had fairly advanced prostate cancer at 60 I had radiation treatments and hormone therapy . I have had pretty much zero libido since. My zest for life is pretty much gone since. Thank you for your videos.

[@joemaxwell1044]

Im 2 years older and entering this nether world

[@Jansenwilliams6494]

What other side effects did you have ,I'm about take 5 days for 4 weeks, what should I expect? If you don't mind sharing

[@maxthemagition]

I was 60 years old when I got a medical examination through my American company, The report highlighted a high PSA of 6.4 which I ignored, because I did not know what PSA was. When I was 76 years old after many wonderful years in retirement, I visited a doctor because of many visits to the toilet during the night.....My PSA was found to be 11.4 and after an MRI and Biopsy, a tumour was found localised in my prostate with a gleeson score of 4/3 which is intermediate cancer. Because of my age, my surgeon said that I was too old and my prostate too big for an operation, so it was radiotherapy and 6 months hormone therapy. Today 7 months after radiotherapy I am almost back to normal and enjoying life again after the side effects wore off, including getting erections etc I still feel tired sometimes but I suspect my testosterone levels are slowly returning to normal...I hope so anyway. PSA is very low and I hope it stays that way....

[@federico1974]

61 year old here gleason 4+3 I had radiation + ADT 6 months Eligard I am worried if I ever ejaculate again.

[@maxthemagition]

@@federico1974 I doubt it but you will probably get orgasms.

[@sharonbarlow1506]

There is also the issue of the spouse who might be post menopausal, does not have a high libido but more than the husband who is on ADT. It is super difficult 😢 Cancer especially prostate cancer affects spouses just as much as the man going through cancer and treatment just in a different way.

[@gvet47]

The terrible sweats day in and day out are far more of a problem for use older men. There are many ways to satisfy your older woman.

[@leonardola9161]

Its rough on both the husband and wife yall will get threw it...

[@sivakumarachanta]

Thanks a ton for the very informative videos. These reduce anxiety and offer pragmatic advice. I am 65 yrs old and was diagnosed with Gleason scores ranging from 4 to 8 about 2 years ago. I had undergone IMPBT - proton beam therapy for 6 weeks in 2022 & have taken 2 years/ 8 shots of leuprolide. My PSA was 14 prior to IMPBT & ADT. Now PSA has been consistently low at 0.01 ever since ADT started and maintaining same. Now I have started the holiday as suggested by my radiation oncologist and urologist. I do have occasional and random urinary issues. Otherwise I am in good shape thanks to my strength training with body weight and external weights. At 65 yrs, I can still do 10 pushups and 3 pull-ups. These videos along with my doctors advice , have helped me to take informed decisions. 😀🙏👍

[@gordonculp3646]

Excellent video. I'm impressed the way you have recently zeroed in on the testosterone deprivation pluses AND minuses. Thanks!

[@Vincent50]

Thank u yet again for a informative video. This will help me talk with my Dr about my ongoing treatment of hormone therapy. Your previous videos helped me to choose a treatment that was best for me since I found out last Summer I have prostate cancer. Please continue to give us these great videos. I will surely donate to get more videos. Thank you again.

[@mabellam3622]

My husband had ZOLADEX injection and took Erleada for 6 months before radical prostatectomy at September, 2023. Now his testosterone is very low 0.7, PSA is 0.008. So if his testosterone come back to normal, will the PSA go up and prostate cancer come back?

[@TERRY-cb2ku]

I'm 73 and have a pretty good libido and fair erections with 5 miligrams Cialis daily. Still in the diagnosis phase of possible prostate cancer. According to MRI scans, the 8mm lesion is confined to the capsule. If it's a Gleason score of 3+3 or even a favorable 3+4, I hope to just do active surveillance or at most radiation. I want to avoid hormones all together. I have an appointment next week to schedule a biopsy. I still have hope.

[@edwardbertorelli7358]

I took darolutamide for six months as part of radiation therapy it did not affect libido it's a second generation drug

[@robwells230]

Taking short term ADT may well be your best option. ....Just ensure that you are aware of ALL the horrific quality of life destroying side effects of this cruel and barbaric treatment and the possibility of long term side effects. ...Once you have weighed all the facts, you can give FREE AND FULLY INFORMED CONSENT. It's easier to ride out the rough times if you know that it was your decision, not imposed on you like you were a concentration camp inmate. Best wishes

[@richardratcliffe9698]

I am three months into ADT therapy and five days into radiation.. Gleason 3+4 with localised advanced PCA - I had surgery and the wait and see but PSA started to rise from zero immediately post. I have been told and have read studies that consistent exercise plus good nutrition can ameliorate all of those effects.. that plus viagra or similar an help on that front as well?

[@jm-bv1wh]

@@richardratcliffe9698 Just my opinion, but I think that you may have heard wrong, although each person is different. You may find that you lose all motivation to exercise after having ADT. Good nutrition has not helped me at all. 12 mos. of ADT ended 3 years ago, and still can't lose 30 pounds that I've gained. Gynemastica continues to get worse. Loss of body hair, muscle mass and strength. Loss of libido. Viagra and levitra do not work for me at all anymore. At least get informed consent from doctor, something that I never got. No mention of ADT side effects at all.

[@colemant6845]

Great Questions asked... Great Information provided! PCRI is THE BEST Prostate Cancer Information service offered ANYWHERE!. Thank You Mark and Alex.

[@billwestervelt2393]

As someone who has done 12 months of Lupron and is now two months Lupron free this has been extremely helpful in helping me know what to expect in terms of Testosterone recovery.

[@falseye60]

Thank you, Doctor! I'm 63 y.o. and started watching you videos since I've been diagnosed with prostate cancer in October 2023. Gleason 3+4=7, PSA 20. It was terrible news for me, my wife and all of my family, because I didn't experience any symptoms. But my urologist insisted on the biopsy and here I am. Your videos gave me the hope that my diagnosis wasn't death sentence. And I was really prepared good before every appointment with my urologist, medical oncologist and radiologist. I mean that I knew what questions to ask and what my treatment options were. Now I've been 5 months on Zoladex injections and I just started Erleada 240 MG daily. My last PSA was 0.8 and my doctor was very satisfied with this reading. I am still waiting for my radiologist appointment to find out my options for this treatment. You just explained very vulnerable topic for any man who undergoes the ADT. Thanks again!

[@joemaxwell1044]

So you are on hormone therapy for months but have not had any radiation treatment yet?

[@leonardola9161]

Im 63 gleason 7 about to do 28 radaition treatments august 2024

[@kitm2351]

These videos are a God send …. There is a segment of the patient population that are Not your mainstream clients … while I hate the label. I am in that group called trans females and unfortunately we fall prey to this disease as well. Fortunately for us breast enlargement is a positive side effect … in addition the risk of other traditional female issues ie hot flashes etc only add to our sense of credibility as women. But all that said you might wish to address what is likely a growing segment of the prostate cancer population.

[@robwells230]

At last, some real honesty and integrity from PCRI. Your previous videos falsely asserted that ADT was reasonably well tolorated when it is not, and it has horrific quality of life destroying and life shortening side effects. Congratulations on your evolution into the reality that men need to be fully informed in order to give FREE AND FULLY INFORMED CONSENT. Happy to see you being truthful and objective.

[@buzzardbombshell3066]

Four months into a six month shot of Lupron, every morning I walk ,ride bike,pushups, lift mild weights, my quality of life is destroyed just have to deal with this ADT prison sentence ,gleason 4+3, psa 5.2 , 28 radiation treatments, 64 yrs. old.

[@robwells230]

@@buzzardbombshell3066 Fasten your seatbelt. This ADT CASTRATION road is about to get a while lot rougher. Side effects get a lot worse as the months go by. Actually, the first month is a breeze as your testosterone level doubles initially. Then all hell breaks loose, and the horrific side effects of this quality of life destroying toxin get worse and last for years after ADT shots expire and may well be permanent.

[@robwells230]

​@@buzzardbombshell3066 Where you informed beforehand about ALL the horrific quality of life destroying and life shortening side effects of ADT??? I certainly was not, and was coerced, deceived, extorted and intimidated into this cruel and barbaric ADT. My side effects were so deadly and insufferable that I refused any further ELIGARD after the first six month shot expired, and yet, I remain partially castrated even a year and a half later with little hope of ever recovering my T.

[@robwells230]

@@buzzardbombshell3066 Just wait.. Side effects get worse as time goes by, and linger for years after ADT is finished.

[@robwells230]

​@@buzzardbombshell3066 Hold on to your hat... The horrific side effects are just beginning to kick ass and get much worse even for months or even years after those toxins are supposed to expire. I refused further ADT CASTRATION after my first six month shot of Eligard was supposed to expire and now, 18 months later, my testosterone level remains less than half of the normal minimum. Good luck on this rough road

[@henrydufour9688]

Important information

[@robgerety]

I'm also interested in better understanding what impacts low testosterone has on men aside from the impact on libido.

[@commonsenseisdead]

I was diagnosed with Low T around 6 years ago when I was in my late 50's. From my experience I can tell you that low T also affects mood, energy, 'zest' faster loss of muscle mass, and my mental acuity, sharpness. I was on a pretty low dose TRT which made a world of difference for me in all of those areas. I've has to stop TRT because of a recent cancer diagnosis ... recent labs revealed a T score of 183 / Free Test 1.9. I don't feel like total crap, yet, but there is a notable difference in my QOL.

[@ivork2373]

I'd say what needs to be better understood is the effect of low testosterone on systemic body inflammation which could be just as, if not more, serious problem to patients on ADT treatment.

[@vincentdisalvo-yv3ge]

A really great program and an asset to the public concerning prostate issues. A question: Having had prostate cancer and treated by radiation followed by testosterone deprivation, ( I was given Lupron injections every six months for a total of eighteen months) I was told by my Urologist that this treatment affects the bones and that this would lead to a crippling affect as I age. I had the cancer treatments in my eighties. Can you expound on this ? At my age, I'm now 90 I have absolutely no feeling or interest in sex although I had a very active sexual life since the age of ten. I had sexual activity prior to my radiation treatment now everything had died. Am I asking for too much at my age ??

[@captainoates7236]

Libido is only one side of it. I've just come off 3 years of zoladex in the UK and hopefully my testosterone will return to some extent given time. The other side effects of ADT are osteoporosis, loss of muscle mass, weight gain, lack of energy and mood changes as well as the usual hot flushes. The advice seems to be that exercise should alleviate most of these. I am 65 and I have always kept in shape and am currently doing weights, circuits and running regularly but whatever I do I am not increasing my strength or fitness. I was just wondering if my testosterone would return then that might change.

[@exxxel22]

Thank you so much for great information.

[@clemchirpich4907]

Thanks for your efforts to provide useful information.

[@leonardola9161]

Very good info. Thank you

[@Marc_de_Car]

Thank you

[@patrickdrury1480]

"10 year outcomes identical." Comparing hormone therapy indefinitely, to stopping hormone therapy. (15 minute mark) "It is the exact same molecule." When discussing ADDING pharmacalogical testosterone.

[@rickeybell5700]

Hi, I had 8 weeks of radiation and 2 years of lupron 6 years ago and have had a undetectable PSA for 6 years. (PSA less than .13. my testosterone level is 84. My doctor is ok with me going on trt. What are your thoughts? I had Gleason scores of 3+4,4+4 and 4+5 when diagnosed. It was found early with a PSA of 4. I would very much appreciate your thoughts on the trt.

[@n.c.b.8832]

Thank you so much for taking the time to help educate men with prostate cancer, superb videos, Sage 4 Gleason 9 my Oncologist put me on Prostap told me it would be for life and hopes he never sees me again, It would be easy for me to take a holiday from hormone therapy but the follow up, monitoring , PSMA Pet scans , radio, no chance where I live in the UK , NHS absolutely on its arse. Poor sleep bothers me more than no sex, my life is so much calmer without the testosterone , I actually wonder how different my life would have been had my mother had me castrated at birth Phil

[@leonardola9161]

I took lupron and have very little sex drive. Mood swings Hot flashes Depression Fatigue Body aches

[@RhysRobinson8822]

At 77+ years old, ADT is a damn good trade-off for loss of libido.

[@mountaindan1840]

I did not hear a specific discussion re penile atrophy. For me, it has been awful.

[@robwells230]

Sadly, men are not warned that ADT causes the total destruction of intrinsic libido and hense, no normal erections. Lack of erections results in permanent penile tissue atrophy due to lack of oxygenated blood into penile tissue. But, even without libido, men can often achieve sufficient erections with visual, mental and physical stimulation and the help of 5 mg daily of Cialis. Penile injections may also be necessary Penile tissue atrophies without erections, just like muscles atrophy without exercise, except that penile atrophy is permanent. It is critical to attempt to get daily erections by whatever means necessary in order to preserve sexual function, or at least to minimize atrophy. USE IT OR LOSS IT!

[@joemaxwell1044]

Im wondering can someone who is newly diagnosed with high-risk prostate cancer (Gleason 9) that hasn't spread yet but needs treatment (surgery or radiation) do chemotherapy first as opposed to the other two?

[@handonmgt]

Because you might not need it. Primary considerations are prostatectomy vs radiation. After the mass is dealt with, monitoring your PSA levels will dictate your care plan. If surgery and/or radiation eliminates your PSA (below .2) you are considered cancer free. If your PSA is elevating, than your doctor will discuss hormone deprivation therapy, salvage radiation therapy and possibly chemo. Stay strong. Exercise. Keep away from anything from a cow. Best to you.

[@joemaxwell1044]

@@handonmgt Thank you. I have always liked horses instead of cows.🙂

[@WhiteNacho]

I used to race a Bultaco Lobido.

[@marinefarmer7494]

off topic but I don't understand that on one side they say.. Gleeson 6 will never metastasize then on the other 50% of patients with Gleeson 6 go on to have treatment within 10 years.. Can gleeson 6 change to Gleeson 7.. Anyone. Please help.

[@fredwelf8650]

The Dr did not differentiate between stages, only between ages. Was it assumed that hormone treatment is mostly for men with metastasized prostate cancer?

[@joemaxwell1044]

It seems hormone therapy goes with the radiation as Im told you do not need the hormones if you have surgery,.

[@Jansenwilliams6494]

It's killing my sleep more than anything plus zero libido

[@yiqingzhou5172]

same for me, my sleep is # 1 problem.

[@sharonbarlow1506]

When you say “6” months of lupron treatment does that mean 2 injections, 1 every 3 months or 6 full injections

[@robwells230]

One six month shot is exactly the same as two three month shots I recommend starting with a three month shot to see if the side effects are tolorable. But, beware, the horrific side effects get significantly worse after the first three or four months and become insufferable for many men. Orgovyx MAY be a better option due to its more predictable T recovery and reduced cardiovascular risks. Just don't fall for the BIG PHARMA SALES PROPAGANDA that doctors parrot that the effects are generally well tolerated. They are horrific and life threatening. Ask your doctor if he has personally been on ADT CASTRATION for two years... If he hasn't, he doesn't know what he's talking about, he's just repeating the drug maker's sales pitch

[@jimwatson3833]

WHY INCREASE OR REPLACE TESTOSTERONE IF YOU HAVE SPENT TIME AND MONEY TO DESTROY TESTOSTERONE?

[@jdotoz]

Because if the cancer is gone or beaten back to a tolerable level the side effects may no longer be worth the benefit.

[@larrychrisentery6671]

I had that treatment in 2009 it was horrible my testosterone never returned to normal before the infection killer thing was my Gleason was 7 and psa was 6 and 7 went down below 4 than back up to 6 I didn't want the hormones therapy but they assisted that I should nightmare than I couldn't even climax for a long time to this day things aren't the same oh well and some doctors even ask why did they do that to you at MD Anderson it was done at MD Anderson in 2012

[@corgiowner436]

You minimize the side effects of chemical castration but they are permanent.

[@jm-bv1wh]

Yep. Three years off Lupron this month, and nothing has gone back to normal, and weight gain and gynemastica getting worse.

[@corgiowner436]

@@jm-bv1wh I feel you. I will never be the same after ADT.

[@theburtons49]

I havent been able to have sex since my treatment and it has totally destroyed any interest in Sex. It has also left me with a deformed Penis. I have had injections in my Penis which is a temporary fix which you have to administer yourself. This treatment has totally destroyed my Sex Life.

[@John-the-Bass]

I agree. Same for me.

[@Vincent50]

@@jm-bv1wh Oh No! Is this what I have to look forward to?

[@rogerembry4777]

The pills didn’t help me

[@corgiowner436]

Me either. If you don’t have blood flow issues they don’t help.

[@newtexan1]

Why are you blocking testosterone? My husband was it on it for low and Cialis. And diagnosed with prostate cancer? What are you talking about? I can’t follow this conversation and it’s frustrating!