Prostate Surgery and Sex – the Testosterone Connection

What amazed me most about testosterone? Three things. First of all, I thought that it was one of those things that we could ignore. I had no idea that when the hormone was low, that it could make you feel like a truck ran over you. Secondly, doctors don’t like to talk about it. And lastly, everyone on the Internet is talking about it, for some reason, and has a product to fix low testosterone issues. Go figure. Why now?

Background

This post is part 2 to the post titled “Is Sex Possible After Prostate Surgery?” It might interest you to know that that particular post was the most widely read out of the forty or so articles that I have posted in the last three years. I think that happened for a few reasons. The article is based on a real life experience. The best blog posts are those that relate real life experiences.  People want to read about real life experiences. The topic for Part 1 is one that most authors will not talk about openly; prostate cancer and its impact on sex.

Part 1 covered PSA testing for men and prostate cancer diagnosis which leads to prostate gland removal (which is just one of the several options for treating prostate cancer). The article went on to discuss the impact of prostate surgery on a man’s ability to have normal, and meaningful sexual intercourse after prostate surgery. Again, there are options. But the one that I discussed in detail required  another surgery to install a penile implant when normal erections are no longer possible.

That’s where we left off in article 1. At that time, I thought that was the end of the story. But it’s not the end.  Again, I did not anticipate what was to follow.

I had my prostate gland removed in July 2010. Two years passed before my spouse and I considered options for restoring normal sexual relations. But that’s not the subject that I want to address in this post. Something happened to ME that was very subtle and practically unnoticeable.

I became a different person.

I’m a typical type A personality. Hyper-active, always up-beat, on the go all the time, boundless energy, I get things done. My father told me that there are three types of people in the world. Those that watch things happen, those that make things happen, and those that wonder, what happened? In my family, I’m the make it happen guy. When my wife or kids get stuck, they come to Dad because they know that he’ll find a solution or a work-around, make a gut decision, and then he’ll make it happen.

Over those two years since my surgery, I not only gradually lost my energy, I lost my interest in things that I used to enjoy doing. My focus was gone. Thinking and concentrating became an effort. I slept more. I felt depressed all the time, which has never been typical for me.

I put up with this for quite a long time. And then I had to do something because it was driving me crazy and I couldn’t stand it anymore. So I went to talk to my family doctor, whose specialty is internal medicine. He said that I was depressed, which I found hard to believe. But I had  no ideas or theories to offer.  So I accepted his recommendation to take a prescription anti-depressant medication.

That lasted for about two months. The medication slowed me down even more. I would get up in the morning, have breakfast, and then go back to bed again. I would wake up for lunch, have lunch, and then take a nap. By 2 P.M. in the afternoon, I felt like I could do something, but I had no idea what I wanted to do. I threw the rest of the prescription pills in the garbage and decided that depression was not my problem.

So What Is the Problem?

You know when something is not right with your body or mind. We all know when we feel good or when something just isn’t “clicking”. We may take something or do something to feel better but often it doesn’t work and leaves us still guessing what the problem might be. I knew something was wrong. But I just couldn’t put my finger on it.

In desperation, I used my symptoms as search terms and started searching the Internet for the solution to the way that I felt.  And something very interesting started to reveal itself.

The Testosterone Connection

I’ve heard of it, but what is it? I knew it was a male hormone and had something to do with sex drive. But what does that have to do with me and my problem? I didn’t have a problem with my sex drive.

Testosterone is a hormone made by our bodies and is responsible for the normal growth and development of the male sex organs, and for maintenance of other sexual characteristics. In men, testosterone is produced in the testicles, the reproductive glands that also produce sperm. The amount of testosterone produced by the testicles is regulated by the hypothalamus and the pituitary gland.

But women also have testosterone. A woman’s ovaries produce both testosterone and estrogen. Relatively small quantities of testosterone are released into her bloodstream by the ovaries and adrenal glands. In addition to being produced by the ovaries, estrogen is also produced by the body’s fat tissue. These sex hormones are involved in the growth, maintenance, and repair of reproductive tissues. But that’s another subject. Let’s get back to testosterone in men.

Normal  effects of testosterone in men may include:

    1. Growth and maturation of prostate, and other male sex organs
    2. Development of male hair distribution, such as facial hair
    3. Changes in body muscle mass and strength and fat distribution
    4. Sex drive and sexual function
    5. Mood and energy level
    6. Bone strength

What does testosterone do in the body?

The testosterone hormone is raging in men when they are approximately ages 15-25. The same is true for a woman’s primary sex hormone, estrogen. Although her sex hormones peak a little later than a man’s; usually until she is 30-35. There is a reason for that. The sex drive during that period goes nuts. A Higher Power determined that it’s time for humans to think about procreating. So we have a built-in mechanism that triggers our bodies and minds to give more thought to sex and procreation (producing offspring). That’s how our species sustains itself over the long term.

What I found to be interesting is that males begin to lose 1%-2% of their testosterone production per year beginning sometime in their 40’s. The process continues into old age. This process causes men to slow down and feel old. Normally, this whole thing doesn’t bother most men. Some don’t even notice it. They feel that it’s natural to slow down in old age and become less active and more sedentary.

A small percentage of men, like myself, cannot tolerate this. I’m sure that you have all met men in their 60’s who are go-getters and have minds that are sharp as a tack. That’s the type that I’m talking about.

But then I read during my Internet searches that men who have had their prostate gland removed produce an average of 13% less testosterone than normal. And that’s in addition to the 1%-2% testosterone loss that a man will experience beginning sometime in his 40’s. Yikes!! I decided that I needed to look into the symptoms of low testosterone (Low-T).

Here are those symptoms of Low-T in no particular order:

    1. Chronic fatigue
    2. Feeling depressed
    3. Lack of focus
    4. Loss of interest
    5. Decrease in libido (sex drive)
    6. Decrease in strength and endurance
    7. Require more sleep

I Found the Problem!

These symptoms described my problem exactly! I had no idea that Low-T normally follows prostate surgery. And I had no idea  what Low-T symptoms were. I just knew that I felt lousy enough that I had to keep pestering this issue until I found a solution.

All of these symptoms crept up on me slowly over two years until the situation became unbearable. I confronted my urologist and asked him what we were going to do about this problem. I could tell by the look on his face that he wasn’t as excited as I was about my discovering the probable cause of my feeling of misery.

I had already taken matters into my own hands by having my family doctor test my free testosterone level. It was a dismal 195. The normal range for men is 300-600. This test confirmed that I was experiencing the symptoms of Low-T and that my life would not get any better until I was treated with a testosterone supplement.

But my urologist explained that there’s a big problem. That suggestion scared the hell out of me because I had no intention of living like a vegetable for the rest of my life.

The problem is that giving testosterone to a person who has had prostate cancer (or any cancer) is like throwing gasoline on a fire (his words). If there is one cancer cell still running around in my blood stream, testosterone feeds that cancer and makes it worse. Cancer loves testosterone. Go figure. The one substance that a man needs in order to feel and act like the man that he is supposed to be (and I’m not referring to sex) is the same substance that cancer’s feed on.

On a side note, women, that applies to you too. Cancer in a woman feeds on estrogen.

But there is also an up- side. Studies have shown that normal testosterone levels contribute to healthy men in other important ways. Normal testosterone levels are necessary in men because testosterone plays a key role in regulating the heart, preventing diabetes, and regulating the lipids in the blood stream in order to thwart obesity and metabolic syndrome. Testosterone also helps to prevent osteoporosis in men. And the real clincher – studies have shown that men with normal testosterone levels live longer than men with Low-T.

So it’s a two-edged sword. In a  nutshell, if I treat what is causing me to feel miserable daily, I risk cancer again if a cancer cell is still floating around in my blood stream. But I’ll live longer and my quality of life will be much improved. If I do nothing, I’ll die sooner, I get to feel miserable for the rest of my life, I’m more likely to get fat or get diabetes, a heart attack, or osteoporosis, but I’ll avoid feeding any cancers that may be lurking in my blood stream. What a marvelous deal!

My urologist’s position is this. He has been testing my PSA for almost two years to insure that, when he performed the surgery on my prostate gland, that he left no cancer cells behind. All of my PSA tests have produced undetectable results – that’s good. Once I reach the two year mark, which will be July 2013, he has no issue with treating me with a prescription medication for Low-T, and continuing the PSA test in order to monitor any potential cancer threat. Now that’s an offer that I could not refuse.  Although this course of action does require that I feel miserable for the next four months (March-June).

I want this to be clear. There are many urologists and doctors who will not give testosterone supplements to a former cancer patient. As doctors, they do not want the risk. When this happens, and you are determined that you are willing to take the risk of another cancer in order to get your life back, find another doctor.

I’ve outlined the trade-offs. Like most things in our lives, it is not straight-forward. There are risks despite what decision you make. Unfortunately, the “C” word scares the daylights out of most people. So you have to ask yourself, is the risk of contracting a cancer that may either be treatable or terminal, worth your being able to lead a normal, fulfilling, healthy, and longer life?

Before you answer that question, remember that your doctor will be monitoring your blood in search of PSA (prostate specific antigen). That is the antigen that your body produces when prostate cancer has been present in your body. Other cancers do not stimulate the production of PSA. They may not be detectable via a blood test. The idea here is that, since you have had prostate cancer, the introduction of a testosterone supplement is far more likely to stimulate one of those cancer cells IF ONE EXIST ANYWHERE IN YOUR BODY.

Personally, cancer has never scared me to death. So the decision for me is a “no-brainer”. I learned a long time ago that it is foolish and a waste of time to fear and worry about something that is totally outside your control. If I am to die of some form of cancer, there is absolutely nothing that I (personally) can do about that.

So What is the Plan?

The plan is to wait until two years after my prostate surgery, which will be July 2013, and then begin testosterone supplementation. For the months March-June, I will pursue “natural” testosterone supplements. There are many foods and plant extracts that stimulate testosterone production. My hope is that using “natural supplements” will do the job and I may not need prescription supplements come July. With success and no surprises, that should be the end of the story. Stay tuned.

Foods that boost low testosterone:

    1.  Oysters
    2. Lean beef
    3. Beans
    4. Poultry
    5. Cottage cheese
    6. Eggs
    7. Broccoli
    8. Cabbage
    9. Brussel sprouts
    10. Garlic

Natural testosterone boosters:

These are mostly supplements that athletes and body-builders take to increase testosterone and build muscle. There are many. Some are very good and some are just “snake oil”. I won’t mention specific brand names because I do not endorse any. Use your best judgment when purchasing. There are some very good products available but you really have to dig deep to separate the good ones from the useless ones. In my research, I noticed that substances that stimulate testosterone are often coupled with natural steroidal properties. These are often plant or seed extracts from exotic places such as South American or Africa.

Fenugreek is a spice that can be found in most spice cabinets.  A 2011 study at the Australian Centre for Integrative Clinical and Molecular Medicine found that men aged 25 to 52 who took a fenugreek extract twice daily for six weeks scored 25% higher on tests gauging libido levels than those who took a placebo. It boosted testosterone by 25%! They didn’t specify dosage in the article. So I checked other sources to see what a normal capsule of fenugreek contains; 2,000 mg. In many Asian cultures where fenugreek is common in their diet, it is thought to be an aphrodisiac.

One interesting fact that attests to the safety of fenugreek in the diet is that it is still used today to stimulate breast milk production in mothers who are having a hard time nursing their babies.

Prescription Testosterone Supplementation

The primary prescription products are Androgel, Androderm, and Axiron. Consult your urologist before using any of these products. Supplements are usually gels, creams, or patches. Injections are also available from your doctor.

One important characteristic of these products is that they are applied to the skin; usually the shoulders and back. Skin-to-skin contact of the application site with another person can transfer the medication to that person. This is particularly bad if testosterone is transferred to a woman. This can be harmful to your partner. If you plan to have skin-to-skin contact with your partner, take a thorough shower first.

Conclusion

In conclusion, I want to summarize the important points that I made in both posts on the subject of Prostate Cancer/Surgery/and Sex.

  1. Early detection of prostate cancer via scheduled PSA testing (at least once per year) is mandatory for men after the age of 40.
  2. Prostate cancer is rarely terminal. There are multiple options for treatment.
  3. Even with radical prostatectomy, multiple options are available to insure that normal sexual relations are realistic.
  4. Expect a prostatectomy to reduce testosterone levels. However, testosterone supplementation, whether via natural products or prescription products, can resolve this situation. Consult with your doctor.
  5. 90% of men with penile implants agree that sex is better with the implant than it was before the implant. Sex on demand, with a sustainable erection for as long as desired, is a desirable side-effect of an implant. The satisfaction rate among partners is even higher that that of men who have had prostate surgery. This is not possible without the implant.
  6. Although the procedures that I have outlined do come with inconveniences, the final outcome, and a positive attitude can produce rewarding and satisfying results, and even some benefits.

References

Is Sex Possible After Prostate Gland Surgery? – Part 1 to this post published 1/13/2013

Prostate/Surgery/Sex Photo Gallery – photo gallery published 1/13/2013

WebMD is a great source for information on Low-T.

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