Exploring ways to maintain libido on ADT

Loss of libido is one of the many distressing effects of Androgen Deprivation Treatment (ADT) commonly experienced by men with advanced or recurring prostate cancer – and of course also affecting their partners. The experience has been described as “watching my manhood fade away.” New studies are finding safe ways to maintain libido on ADT. One increasingly real option is to bolster the naturally-occurring “female” hormones instead of simply blocking “male” hormones to fight prostate cancer. Patients are reporting much improved libido, with the same cancer-fighting outcomes as those on conventional ADT.

If you live in Canada or the United States, please contribute to the current study highlighted in the box below. It only takes a few minutes and is completely anonymous. You can help by sharing your experiences and opinions if you have been diagnosed with prostate cancer, whether or not you are on ADT.

How estrogen supplements improve male libido

Even though some men do experience zero libido when on ADT, it’s a  myth that this is so for all men on ADT. For an eloquent and erudite articulation of the evidence for ongoing sexual interest and activity for men who are chemically or physically castrated, read this 2012 letter to the editor of an andrology journal. Its authors include both high level scientists and ADT survivors. They followed up the letter with a detailed scientific paper concluding that estrogen can maintain some libido in androgen-deprived men.

A prostate cancer survivor who is on lifetime ADT got me interested in this route a few years ago. He uses estradiol patches to both keep his testosterone suppressed and supplement estrogen in line with the above findings, and the way I remember his anectodal report to me is as follows:

I definitely feel much more energy on estradiol than I did on conventional ADT medication. I have less hot flushes, and my libido is also better. Yes, I do have slightly bigger “man boobs” than I would otherwise have at this age, but I have retained my beard and general male features and I am happy with the outcome.

I’ve been curious about this possibility ever since, and so welcome the fact that it is being more widely researched, including the current North American study. The principal investigator told me they would like to get more responses including from men who have never been on ADT. I completed the survey and discovered a lot of interesting scientific information about the different ways ADT works.

New study allays safety concerns about estrogen supplementation for men

While the positive benefits of estrogen supplementation have been known for a long time, there were reports of increased cardiovascular and other risks that kept most people away from trying this route. However, positive reports are beginning to emerge from a 15-year study known as “the PATCH trial.” You can watch a fascinating video interview with Dr Duncan Gilbert on UroToday summarising the study and its outcomes. Its technical description is

comparing transdermal estradiol with LHRH agonists for androgen suppression in non-metastatic prostate cancer

My best plain-English translation is that they tried giving men supplementary estrogen via transdermal patches. They were boosting what we would call a “female” hormone to accomplish the same results as ADT, but with less gruesome side effects. According to Dr Gilbert, the key benefits of transdermal estradiol include

• reduced hot flushes
• improved bone mineral density
• improved quality of life (for which you might read libido and sexual function)

They do acknowledge increased gynecomastia (man boobs). Importantly, according to Gilbert , the study “demonstrates cardiovascular safety.”

For those interested in more detail, please see the presentation to the 2024 European Society for Medical Oncology (ESMO) Annual Congress congress by Dr. Ruth Langley.

I’m not an expert on the medical aspects, including differences in which treatments are licensed in different countries. Nor am I on ADT. I offer these pointers towards some experts because there are so many people out there struggling with the impact of ADT on their lives.