So, even with Cialis I am having issues getting erect and certainly having an orgasm. Some questions for the group:
1. How much of this is the hormone therapy? Meaning, likely by now (more than 2mths on ADT) my testo has dropped very very far right?
2. Why doesnt Cialis help?
3. What is my outcome? I heard from some doc online that more than 6mths of ADT often times mean no recovery in regards to erections
...anything else you want to share in this regard would be appreciated.
Everyone is different depends on how they were prior and what procedures they had. Me surgery, radiation & adt therapy 18 months, no erections during most of this, Cialis, Viagra did not work but did us Bimix injections for erections and it works. Off ADT for sometime having some small nighttime erections and desire back.
ED meds only work if you have libido.
Not totally true. They worked for me for quite a while even after being on ADT for 4 years. They stopped now.
Only Trimix works with or without libido. For ED meds (e.g.,Cialis, Levitra, Viagra), you have to want to have sex (libido). Some men are able to have some libido in spite of no testosterone.
I haven’t been on this forum for 5 months and boom - TA delivering the facts.
I’m 7 1/2 years on Lupron now (now 53). I don’t think about sex at all, the meds never helped me because at TA said - no libido.
Honestly the shrinkage is so much, probably couldn’t figure it out anymore.
If you want to have a libido- you need to medicate to treat that. The best stuff (MDMA) is unfortunately illegal now, but clinical trials are starting with it.
So if you want make it happen tell your Dr you want some Viagra and some really pure FDA research-grade MDMA (aka ecstasy/ Molly). That should help with ED and libido.
MDMA increases the feeling of intimacy with others, but it is an amphetamine - 3,4-MethyleneDioxyMethAmphetamine. Amphetamines, like all molecules that are chemically similar to adrenaline (epinephrine), will interfere with erections. In fact, epinephrine is given for priapism (erections that last too long) for that reason.
thanks for the replies so far. Good point on Libido - I don't feel like my Libido is totally gone but for sure the thoughts are not making their way below.
I also understand the need for respect or whatever the right word is when talking about this. What I mean is to some it might seem like "you have PCa and all you worry about is your sex life???" - Don't get it wrong, I totally understand the full breadth of this but to say "these" type of issues are not terrible is just wrong.
You come across as a considerate and polite fella, at least it’s my observation off the top. Please don’t let ever feel the need to dial back what you need to say or ask in this space however way you need to get it across. Have no fear the facilitators will keep us moderated. I marvel at our teammates here for their wealth of information. Best to you and your hopeful good outcome.
thanks, I am a great guy 
- and the HU team is awesome!
If worrying about your sex life and energy and the things you like to do is an issue, then I have an issue.
What is the point of living without life?
ADT was the end of my sex life. But only while I was on ADT.
When I quit, I used testosterone injections to increase my serum levels. Libido, sex, energy, muscle, bone, energy, red blood cells went right back to where they were.
If a doctor tells you that six months of ADT will permanently remove your ability to have erections, ask for studies and trials that show this. And make sure to make age-adjusted comparisons. Depending on what type of ADT you do, testosterone recovery can take weeks, months, or years. That is where TRT comes in.
Thanks for that note. I hear all the time that I will have to be on ADT for rest of life but i hear others who have went on vacation.
What drives that? PSA staying low for some amount of time?
It could be your MO. PSA low. Maybe you can't stand the side effects (that was my case). There are other options. BAT for CRPC and HSPC (BATMAN II trial). TRT for some men. SPT (constant high T). Some MO's practice this. Including Sartor for select cases.
For me, spending time cuddling and pleasing my wife rekindled my libido.
Even with viagra or trimix, my erections are less stiff than they used to be. Fortunately, they still function enough for intercourse. In my case my orgasms are unreliable, and less intense, but still pleasurable.
Any hope of sex life etc, has gone finito, with decapeptyl Sr hormone injections, when I was 'suspected' of having PC, my PSA is 0.06, they are still checking me, but keep very low profile like my non-existent sex libido, sterile, did I ever have PC in the first place? 😖🙄I'm 67 and single so no great loss? 🙄[personally I believe my Schwannomatosis NF3 had something to do with it, schwannomas on my prostate gland from 2019 which I mentioned more than once🙄, but seems to have NEVER been taken into consideration, after all they are MEANT to know best?😤😒]
OMG! Just read your profile and a few of your posts. You've been through the wringer with your health and the medical system. You must be one tough cookie.
Thanks Carlosbach a real bitter one at present, sorry to HU for being so, wringing out my sores for so long, surprised I'm still here, but I'm a survivor👍
Hi Yzinger,
ADT makes most people totally loose interest in sex.
Myself I never lost interest, but ADT gave me severe ED and stopped all nighttime erections.
I tried:
- Vitaros cream which didn’t work that great.
- Viagra which helped a little.
- Cilais 5mg every day and 20mg 2 hr before sex, which worked somewhat good for a while. I still take Cilais daily.
- Invicorp injections (similar to Trimix/Bimix) which worked great and resulted in erections for about an hour. Injecting into your member doesn’t sound like anything you’d like to do ever, but it’s actually not that bad.
I could orgasm sometimes, but they were dry (no ejaculation) and not as strong. Some people actually report having different and better orgasms on ADT. I was not one of them.
It’s important to take care of your little guy while on ADT. No nighttime erections means atrophy and shrinkage since the natural bloodflow and oxygen transportation has stopped. Daily use of a penis pump is recommended to simulate nighttime erections. Some doctors also recommend weekly Invicorp/Trimix/Bimix injections for the same reason.
I was on ADT (Firmagon and Abiraterone) for 2+ years. A short while after ending ADT everything went back to more or less normal.
I will mot likely have to go back on ADT soon. I absolutely hated it, the sexual side effects being one of the main reasons.
What did you replace it with?
Nothing. I ended ADT two-three months earlier than what was planned.
How can you not go back on adt? Are you cured?
Not cured. Due to some other reasons, life on ADT was absolute hell for me. I ended ADT early in discussion with my doctor.
Ok Mike. Maybe they will find something else that works for you, which is less problematic.
Came close to making the same call, but I'm tolerating Firmagon better for now. I considered stopping ADT entirely, or trying BAT even though I have visceral mets. Tough decision to make, but my last 4 months on Eligard were entirely untennable as a way of life.
thanks for the note. I am hoping I can take a break down the road but for now I will look into the pump thing. I too still have the wants for erections and all that brings 
Viagra helps but is not enough for intercourse but take 25 mg a day for improved penile blood flow. Trimix works well for me. My orgasms are much less intense and difficult to obtain at times. Also on occasion have a functional erection at night. I enjoy the physical skin to skin intimacy and connection with my wife regardless if I reach an orgasm.
You need to upgrade to injections
So glad you posted this as it has prompted so helpful responses from the community, as usual. I identify with the issues and will explore some of the feedback.
I have only three words for this problem, ChineseHerbal Medicines
Which ones?
Red Panex Ginseng, Dan shen, exclusive China Rape Flower Pollen( Ebay). First two mentioned have reports stating anticancer as well. The rape pollen is an erectus x10 takes a few days, but may not be good for PC . I use it very limited basis but it works for me. Yellow Golden leaf Ginkgo is overall good and anticancer Chinese skullcap is anticancer / lyme and I find may help with my peanuts, lol Bonus one more for ya, Yu Xing Cao, My taking of these supps but you do research. Good Luck !
I just saw "Yellow Emperor Tonic" advertised. Anyone know if it is it real or a scam?
HUANG DI JIU - Yellow Emperor Tonic is a china herb, China herbal treatments have been used for thousands of years, I think the bad narrative started in the 60's when dubiuos sex peddlers were selling fantasy in a bottle. I just did a post on china herbals. And African medicinals is another deep dive . The treatment options are in the hundreds So how many conventional options are there. Hmm < not suggesting just saying. I myself want to know about all options.
Thanks for the info. I will do my research
there are so many herbs and so many scams it could take a lifetime to find something that works without the help of a specialist. i have pretty much given up on ever having sex again (other than pleasuring my husband) but if i were i would try to find a well reputed specialist in Chinese medicine and ideally one who knows other Asian remedies. There is a lot of overlap but what might work for you might not be Chinese. I don't think that Chinese or other herbs will work for everyone so it is probably helpful to be examined by someone who can tailor a treatment specifically for you. The Chinese (as pretty much every other culture) are definitely interested in sexual functioning. But please stay away from medicines sourced from endangered species.
I am impressed that you still want one. I quit having sex because I can’t get interested in it. No idea if I could still have one.
Use the pump often if you want to keep it ready as possible, even if libido is scarce or non existent. Cialis too. I didn’t do it on ADT, didn’t care to is all. and have no reliable erections even after ADT and full return of testosterone.
I had excellent function and libido before treatment, but RP and ADT decimated both. Would rehab have restored function for me? It may have helped some but probably not more than that.
if I If you still have your prostate and are on a fixed course of ADT your outlook may be good. Depends on your age (biological especially) and what your function was before.
No one talks about implants much on this forum since we are mostly metastatic and in and out of lifelong ADT. For many of us sex just takes the back burner and stays there. Having a implant would be the equivalent of ‘all dressed up with nowhere to go’.
But the implant works well and if your libido returns -with or without ADT- you may want to consider it.
Injections are a good option and work for many, but I just didn’t like them at all. If I can successfully stay off ADT for 5 years post full return of testosterone (I’m at close to 3) I will get a implant for sure.
thanks for reply. How does one come of ADT and get test to return? Is this remission?
it depends on your situation. If you put some details in your profile you can get more specific answers.
Basically it comes down to whether you are on ADT as part of a curative attempt or to manage the disease long term.
I may be too early in this journey to answer. I am advanced with mets. Have not yet got blood test to see if PSA is dropping as expected. Have that blood test tomorrow and will start chemo shortly after.
Good advice on here. Pumps, pills, injections. Lots of practice. The key is you have to want to do it. If you do, you can have good success. Even if erections don't come back fully you can still enjoy sex
On the other hand, if ADT causes you lose interest completely and permanently you are not alone, and it doesn't have to be sad, disappointing etc. We are getting old, and everything is subject to loss, as I'm sure you know by now. Making the best of what remains is my motto. Great luck to you!
Absolutely take the daily pills to improve blood flow. I was on 20 mg sildenafil and a weekly challenge dose of 100. Pills alone aren't enough though. You have to make the effort to get erecting so the pump idea is probably good. I didn't do anything beyond the pills and ended up developing venous leakage. The blood would flow in so I'd get an erection, but the leakage allowed the blood to flow back out rather than being trapped so it never got fully erect and wasn't going to work. Tried the injection that wasn't enough either. So got a penile implant.
It had been so long that there was shrinkage and both the length and width debased. The implant improved the girth, but did not fix the loss of length. Ended up trying and using a penis sleeve after pumping the implant to get an erection. I got the libido back after I got off ADT. I am also able to orgasm, so that never became an issue fire me, but now ejaculate some urine when I climax. Another benefit of the sleeve is that it contains the urine that I would leak and ejaculate during sex.
I had all my treatment at MSKCC. It happens that they have a men's sexual heath program there, a very good one. Check it out. The Dr I saw and who did my implant surgery was Dr John Mulhall. I highly recommend him. They have great resources for understanding erection and other issues men have (and sexual issues women have for that matter). They are more focused on this being from cancer and cancer treatment so they have some good/specific focused information.
In a nutshell, don't give up, there's more way to enjoy being sexual and having sex even after having PC and the surgery, hormone and radiation treatment, etc. Your sex life isn't over just interrupted and changing.
As T.A. mentioned, Viagra and Cialis only work if you have a libido. One helpful recommendation suggested by Snuffy Myers several years ago was to try Cabergoline. It can help with libido and also orgasisms. I take 1mg twice weekly and indeed it does help, but it takes a few months to work. The downside is that Cabergoline can cause dizziness, so you need to start at even lower doses and increase gradually over several weeks. Check with your MO and see if he will give you a trial RX.
From what I read, it increases testosterone levels. That's not what we want.
Certainly did not increase my testosterone level which is low normal (299). Where did you read that it increased testo?
I tried Trimix and Bimix and both caused preaprism. Cialis helped for a while but stopped. Now I use the pump. I use the Osbon pump. Expensive, but worth it. I used it every day for months and now use it probably five days a week. I had severe loss of length by not doing anything for 4 years. I have regained at least an inch in length but the girth is where the real gains are. I really pump hard and use rings. I am six inches around. My wife loves it. Don't have an orgasm but I enjoy sex a lot.
YZinger, I looked at your BIO and you have a serious case to tend with. Regardless, you like all of us want to preserve, retain or protect as much sexual function as possible, within the confines of the care we are prescribed. What I read in your post is what I have experienced and sadly what happens to most men with PCa (prostate cancer). We are not counseled on, prepared for or made aware of the impacts that needed treatment will make on our sexual function. Dont feel alone in this; it happens to most men; 80% plus from what I read.
Here are some posts that I made that explain what happened to me; hope they help. Understand that your case will most likely require ADT treatment for a long time, years if not life...then know what is going to happen. Take actions when you can. Try to preserve and retain as much sexual function as possible. Its a lot to bear ON TOP of the cancer...but no one tells us what is going to happen to us. I think the Dr's fear we will be 'deer in the headlights,' but who is it that has the cancer? Who must make the decisions on what treatment to receive based on all the relevant information? So my only wish is that Dr's stop treating us like house plants and tell us the good, the bad and the ugly, then let us decide....
From my standpoint, ADT is a great drug for PCa...it can prolong life, make treatments more efficacious and help in the general treatment of your PCa...but it does on hell of a job on your sexual health. Know that those impacts are and make plans now when you can to be in a better place later...Rick
healthunlocked.com/active-s...
What are these ”erections” you guys speak of?
😆
Definitely not the "erections" we spoke of when we were 17.
I describe my semi's with the same attenation to the truth as I use to describe the size of the fish that got away.
I realize I am an outlier...
I am still having satisfying sex 3x/ week, 24 months into Lupron/Zytiga and 18 months post IMRT.
I use 20mg Cialis which I had been taking for a decade prior to my PCa becoming more aggressive.
While I do not think of sex and could easily do with out it. We have chosen to remain sexually active. Once we get naked and start kissing and caressing I am able to get an erection about 90% of time.
No shrinkage, no ejaculations but plenty of orgasms.
A willing and attractive partner combined with great communication are essential in my opinion.
As Henry Ford said "Think you can, think you can't. Either way you are right."
I think serious exercise is an important element for keeping ADT side effects at bay.
See my profile for details
I take 10mg 3 times a week. Its been a couple weeks now.
Please look for sexual health providers for the possibility of injections which keep the muscle in your penis active so when Libdo returns you have tissue that responds Libido is stimulated differently for all of us Important to try to reconnect with what brings you in a stimulated state (at least in the beginning it may not give you an erection but keep at it !) Try Pictures (Porn) , Affection,Conversation. A patient loving partner helps a lot ! Hope things change for you !
No interest right now while on Lupron and Abiraterone. Really curious if my Testosterone is going to return when I finish up next year. I really want to get back in the game if possible. Has anyone tried recently approve OTC gel called MED3000 or Eroxon? Is it as good or better than Trimix or other ED drugs?
To Mr. Yzinger (actually why not)....
My only comment........... To be effective, you must swallow the Cialis tablet. Don't do what many men tried (including me) by balancing it on your erection, that gets you nowhere....Us men are such show offs..........
Good Luck, Good Health and Good Humor.
j-o-h-n Tuesday 10/03/2023 6:09 PM DST
Hi there,Same here, I'm a 73 year old white male. Stared having these problems age 69. Up till then my libido was hitting the roof, erection and ejaculation all good. I needed sex all the time. In 2019 they found enlarged prostate, benign? Started medication - 1, 2, then 3 different. Nothing helped. First I lost ejaculation, (retrograde ejaculation), still good erection. In 2022 had an op, then surprise PC. Went on ADT in may 2022, Zolladex inj. Plus Enzalutamide pills 4 per day. Things went from bad to worst.
No libido, no erection, retrograde ejaculation. Hot flashes and mental effects.
My doc says it's reversible if you stop ADT, but in my case she says this is the only way to keep cancer away.
my friend was stunned that I would pay 400 bucks for the view glass when all you need is the right name vacuum cleaner and attachment. Try at your own risk. Don’t want any thing you have to fish out of the bag! Sorry it’s a serious subject and not that many options available except to go off ADT
I take 40 mg of generic Viagra daily and more as needed for actual sex. It helps. I can usually achieve an erection just good enough for sex. Not great but better than nothing. My libido is way down but not completely gone. Often have trouble achieving an orgasm and when I do the intensity is pretty low. That’s okay. An orgasm isn’t what I miss. Most of all I miss the physical and emotional intimacy of sex and I can get that without an orgasm.
My doc said 1 20 daily and 5 40 minutes before sex do not take any nitrates with this stuff!
I've been on Lupron 5 continuous years. About three times a year, the monkey needs attention. Usually builds slowly. Always enjoyable but quite different than the glory years.
highly recommend the vacuum pump. Early and often.
Keeps the blood flowing and subsequent shrinkage at bay.
6+ years on Hormone therapy, no erections, no orgasms, no desire. I am happier without sex. It is a waste of energy. I am glad my Wife agrees. I put away the childish desires is how I look at it.
Talk to a Radio Oncologist 
Can Xtandi actually kill advanced prostate cancer?
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