Testosterone replacement (TRT) and libido

User

Posted 05 Jan 2026 at 07:19

I had a Gleason score of 3+4, 4+3. I was given androgen deprivation therapy in 2020 (then aged 76/77) prior to radiotherapy. After that my testosterone level partly returned, somtimes in the normal range although always on the low side. It wasn't checked much but was found to be low in late 2024, and that coincided with me having a tendency to become abnormally anxious (although I didn't notice the connection until later.) My libido was also very low, although I could manage a very occasionlal orgasm.

I was sad about losing libido and as my PSA was very low I asked about TRT, on the basis that if my testosterone had been normal, the docs would not have acted to reduce it. I got a flat 'no' from the specialist nurse at my routine follow-up but persevered with asking. After a lot of to and fro between the oncology and endocrinology departments it was eventually agreed in July 2025. However I was so spooked and anxious after warnings about the cancer returning that I couldn't bring myself to take it. But I felt very conflcted and started seriously losing sleep.

As I had never had the chance to have a really good discussion about the risks with a consultant, my wife persuaded me to get a private appointment with a top endocrinologist. He told me that recent research showed that the risks of TRT were likely to be low in my case (although very uncertain after 5-6 years) and the effects on quality of life and other health aspects could well be very positive. So I started taking the TRT (transdermal gel) just over 8 weeks ago. (I later saw an article about recent research and risks at https://theconversation.com/how-testosterone-went-from-prostate-cancer-villain-to-potential-ally-266519.)

Overall my anxiety is reatly reduced, particularly in the physical symptoms, and I generally feel a lot better and more positive. Hot flushes have pretty well gone. However I am very disappointed, now that my testosterone is within the normal range, that there is almost no sign of my libido returning. On only a couple of occasions I started getting some feelings, and that was very little. Am I expecting this to happen too soon? Of course there is a big psychological element in libido and I wonder if I'm getting too worried about it.

At 82 I'm not expecting to feel the same as I did at 62 but I expected more than a big zero. I've been happily married for 55 years and it's a big loss. Any comments?

User

Posted 07 Jan 2026 at 05:11

Roger,

My experience pretty much parallels yours, although my testosterone returned to the normal range without assistance a year after ending ADT [a total of 3+ years without testosterone in my system]. I'm 78 now.

I'm sorry but I can't hep you with how long it should take for the patches to work. My impression is that libido at this age doesn't necessarily match testosterone levels as might be expected. Maybe this isn't surprising. We've aged a few years during treatment and at the time I felt about 10 years older than my actual age, although strength, fitness and other measures have increased since normality returned. I've had a reasonable return of libido but not of sexual "performance". Ideally we should use a penis pump during our time-out, otherwise we lose the potential for erections when libido returns. At this age there's a natural and rapid decline in our ability to have an erection, regardless of cancer treatment. I feel that having a time-out of three years caused some loss of mental and physical"skills" in much the same way as not practicing other day to day skills we use, even if it sounds odd to describe any aspect of sex as beyond instinctual.

I think Andy has posted here on changes in medical attitudes to using HRT after cancer treatment but we're never free from this disease and if we do have recurrence, there will always be a question as to whether the HRT contributed.

Even if the TRT doesn't bring all the results you've been hoping for, it does sound as though it's been worth it. I did read an account of a man in his mid nineties who persuaded his GP to give him HRT for mood and general wellbeing. He said it improved his life out of sight and that sounds as good as it gets.

Jules

User

Posted 07 Jan 2026 at 06:54

Microcolei medical staff are still ignoring the sexual side. My husband mentioned it in his 1st appointment and by telephone, that he wished to keep his sexual function going.He asked for that to be added to his notes, it wasn't. No advice or mention of it at all. We did our own research and bought a pump and after seeing his GP she prescribed some tablets. They think we're all dead from the waist down after 60. Well we're both as passionate as ever in out 70s.

User

Posted 07 Jan 2026 at 07:50

Hi Antoinette

You have absolutely the right attitude. Initially my GP was very reluctant to prescribe a VED but my consultant forced her to prescribe one. I was the same age as your husband when I was treated. As you know our sex life is still great, with many unexpected benefits, thanks to VEDs. Men have to be proactive and determined to re-establish their sex lives. It is not recognised that prostate cancer is a couples' disease: women need as much sex as men do and should not be ignored. ED or lack of libido in men should not deprive women of sexual pleasure, it is the men's responsibility to help their wives/partners for their relationship to thrive. I made sure that while I was recovering my wife's needs weren't ignored by me.

Edited by member 07 Jan 2026 at 07:53 | Reason: Not specified

'Physics is like sex: sure, it may give some practical results, but that’s not why we do it.' Richard Feynman (1918-1988) Nobel Prize laureate

User

Posted 07 Jan 2026 at 09:41

Roger

The NHS is not supposed to be ageist. Sexual health is all part of our well being. A fulfilling sex life at any age has huge benefits for your heart and happiness. You have every right to not want that to diminish. Hopefully your wife is equally enthusiastic. I'm sure you can both explore ways to reintroduce a flane of passion. So much of it is in the mind too I think, and the memory. This is the one person on earth I have this special deeply personal bond with and I/ we want to make the very most of it, physically and spiritually and every which way!

User

Posted 07 Jan 2026 at 11:32

Roger

One easy idea you could try, and possibly your wife too , are pelvic floor exercises. Before he started on ADT I had been doing them with the NHS Squeezy app. It costs a one off fee of £2.99, that's all, and you choose when to do them. I do them 6 x a day. Each one takes about 3 minutes. You can do them watching TV or sitting down, or last thing in bed. There is a version for men for ED and incontinence. Husband does them 4 times a day. It really made a difference. For me it took 6 weeks to have an effect.

The main benefit is it's timed for you, and there is a record of how you're doing. There's also links to help and advice.

It's a virtually free way of helping your body you can start today.

https://squeezyapp.com/men/about-squeezy-for-men/

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Testosterone replacement (TRT) and libido

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