The Hormone Shift

Monday I Turned 60. Tuesday I Started Shutting Down My Testosterone.

That was my birthday week.

Monday, I turned 60.

Tuesday, I walked into a doctor’s office and began a treatment plan designed to drive my testosterone down and keep it there for two years.

Twenty-four months.

I had spent a lot of time thinking about that number.

Two years sounds different when you say it that way.

Birthdays are supposed to make you think about where you have been and where you are going.

This one certainly did.

Instead of simply thinking about turning 60, I was thinking about what the next 24 months might do to my body, my energy, my relationship with Sue, and even the way I felt like myself.

That was the beginning of androgen deprivation therapy.

ADT.

Another abbreviation I had never expected to become part of my vocabulary.

This Wasn’t Just Another Medication

By this point in the journey, medications and medical terminology were no longer new.

But ADT felt different to me.

Surgery happened on a particular day.

Radiation would happen through a defined series of treatments.

ADT represented something that would become part of everyday life.

The treatment plan called for deliberately suppressing one of the hormones my body had relied on for my entire adult life.

And not for a few days.

Not for a few weeks.

For two years.

There was something psychologically different about that.

Why ADT Became Part of My Treatment

My prostate cancer was not a low-risk diagnosis.

I was dealing with Gleason 9, Grade Group 5 disease.

Surgery had not given us the ending we hoped for.

There was still more treatment ahead.

My doctors recommended hormone therapy as part of the larger treatment plan that also included radiation.

The goal was to suppress the testosterone that prostate cancer can use as a growth signal while we moved into the next stage of treatment.

I understood the reason.

That did not mean I was looking forward to it.

Those two things can exist at the same time.

I could believe treatment was necessary and still be uneasy about what treatment might cost me.

I Wasn’t Afraid of the Injection

The injection itself was not the part I had been dreading.

It was what came afterward.

I had done what I always try to do when something important is coming.

I asked questions.

I talked with my doctors.

I read.

I listened to other men describe their experiences.

And I tried to understand the things that could change when testosterone was intentionally suppressed.

The list was not insignificant.

• Hot flashes
• Fatigue
• Loss of muscle and strength
• Changes in bone health
• Loss of libido
• Changes in intimacy
• Brain fog
• Emotional changes
• Changes in how I might feel physically and mentally

That was what I was preparing for.

Not a needle.

A different version of normal.

The Part That Is Easy to Reduce to a Side-Effect List

Medical appointments have to communicate a lot of information quickly.

So side effects naturally become a list.

Hot flashes.

Fatigue.

Muscle changes.

Sexual changes.

Emotional changes.

But reading a list is different from thinking about what those words might mean inside an ordinary day.

Fatigue is not simply a word if you no longer have the energy you expected to have.

Muscle loss is not simply a bullet point if you have spent months trying to rebuild strength.

Libido is not simply a medical term when you have been married for decades.

Brain fog is not simply an item on a handout when you are wondering whether you will still feel mentally sharp.

That was the part I was trying to prepare myself for.

The human version.

Hot Flashes Sound Small Until They Are Part of Your Life

Before beginning treatment, hot flashes were one of the side effects I heard about repeatedly.

On paper, it almost sounds minor.

Uncomfortable?

Sure.

But compared with cancer?

It can be easy to dismiss.

What I was beginning to understand was that treatment side effects do not have to be life-threatening to affect your life.

Sleep matters.

Comfort matters.

Energy matters.

How you feel throughout an ordinary day matters.

Quality of life is not something we should be embarrassed to discuss simply because the disease itself is serious.

Strength Had Taken on a New Meaning

I had already spent months trying to regain strength after surgery.

Recovery had taught me how easily things I once took for granted could disappear.

Now I was entering another treatment that could affect strength and muscle.

That bothered me.

Not because I was trying to win a bodybuilding contest.

Because strength represents independence.

Getting up.

Walking.

Traveling.

Helping around the house.

Carrying things.

Living the kind of life Sue and I still hoped to live.

That made physical strength feel much more important than it had before cancer.

The Part Men Don’t Always Talk About

Testosterone carries a lot of baggage in the way men think about themselves.

Strength.

Sexuality.

Desire.

Confidence.

Energy.

Identity.

Whether all of those things are medically tied together in exactly the way we imagine them is not really the point.

The point is that emotionally, many men connect them.

I did too.

So beginning ADT forced me to confront a question I had not expected cancer to make me ask:

If treatment changes some of the things I associate with being myself, how do I keep recognizing the person underneath them?

I did not have an answer yet.

I still believed it was a question worth acknowledging.

Sex and Intimacy Are Not the Same Thing

Prostate cancer had already forced Sue and me into conversations about sexual function that we never imagined having.

Surgery changed things.

Hormone therapy introduced another change.

I knew loss of sexual desire was something we might have to navigate.

That mattered.

And I think men and couples deserve permission to say that it matters.

But it also made me think harder about the distinction between sex and intimacy.

Intimacy can be affection.

Conversation.

Touch.

Humor.

Vulnerability.

Sitting together when neither person has the right words.

A treatment may force a relationship to adapt.

Adaptation does not have to mean the relationship disappears.

Sue Was Going on ADT Too — Just Differently

The medication was going into my body.

But once again, treatment was entering our marriage.

If my energy changed, Sue would live with that too.

If my mood changed, it would affect both of us.

If intimacy changed, it belonged to both of us.

If I became more tired or needed more help, the person most likely to absorb some of that change was sitting beside me.

That is one of the reasons I have become so intentional about recognizing the caregiver as the co-pilot.

Cancer treatment rarely stays confined to the person whose name is on the medical chart.

The Emotional Part Worried Me More Than I Expected

Before treatment, I found myself thinking about the stories I had heard from other men.

Men who described feeling more emotional.

Men who described brain fog.

Men who said they did not always feel like themselves.

I did not know what my experience would be.

And that distinction matters.

Someone else’s experience is information.

It is not a prediction.

But hearing those stories helped me identify questions I wanted to ask and changes I wanted to pay attention to.

Two Years Felt Bigger Than the First Injection

Twenty-four months.

That was the part I kept coming back to.

I could handle an appointment.

I could handle an injection.

I could handle today.

But when I tried to imagine two years all at once, it felt enormous.

Two birthdays.

Two summers.

Two holiday seasons.

Hundreds of ordinary mornings.

That was when I had to use a lesson cancer had already taught me.

I did not need to live all 24 months today.

I needed to do the next thing.

Get the injection.

Pay attention.

Ask questions.

Keep moving.

Tomorrow could wait until tomorrow.

The Motorhome Became More Than a Motorhome

During all of this, I kept thinking about the life Sue and I still wanted.

The motorhome.

Alaska.

Travel.

The road.

The adventures we had spent years imagining.

At some point, the motorhome stopped being simply a vehicle in my mind.

It became a promise.

A reminder that treatment was not the destination.

There was still supposed to be life on the other side of it.

And hopefully plenty of life during it too.

How Do You Know the Sacrifice Is Worth It?

This is where the emotional side of treatment and the medical side begin to collide.

You accept potential side effects because you are trying to accomplish something.

You want the cancer controlled.

You want the treatment to work.

So eventually the question becomes:

Is it working?

That is one reason the blood tests and PSA results began to carry so much weight.

They were not simply numbers on a portal.

They were information about whether the plan was accomplishing what we hoped it would accomplish.

And that leads directly into another part of this journey:

Living from one test to the next.

Questions I Would Ask Before Starting ADT

Every treatment plan is different, but if I were sitting in that consultation again, these are the kinds of questions I would want in front of me:

1. Why are you recommending ADT in my specific situation?

2. What is the goal of adding it to my treatment plan?

3. How long are you recommending I remain on it—and why that length of time?

4. Which side effects do you most commonly see with the treatment I am receiving?

5. What changes should I report rather than simply assuming they are normal?

6. How should we monitor things like strength, bone health, energy, and other changes during treatment?

7. What should my partner and I know about sexual and emotional changes?

8. How will we evaluate whether the overall treatment plan is doing what we want it to do?

9. What can I reasonably do to stay as healthy and active as possible while I am on treatment?

10. What question am I not asking that you think I should understand?

I Wasn’t Choosing Between Treatment and No Consequences

This was another important mental shift for me.

I was not choosing between:

treatment with side effects

and:

doing nothing with no consequences.

I had aggressive prostate cancer.

The disease itself carried consequences.

That did not mean I had to like every part of treatment.

It meant I needed to understand the tradeoff I was making.

And I wanted that tradeoff to be informed.

Being Pro-Treatment Does Not Mean Pretending Treatment Is Easy

I have said versions of this throughout the journey:

I am not anti-medicine.

I am pro-living.

Those words matter to me because talking honestly about side effects should not be mistaken for arguing against treatment.

I can believe a treatment is appropriate for me and still talk honestly about what frightens me about it.

I can be grateful that treatment exists and still acknowledge what it may change.

I can choose treatment and still ask questions.

In fact, I think those questions become even more important when I have decided to move forward.

This Mile Marker Is the Beginning, Not the ADT Verdict

This is important.

I wrote and recorded this part of the journey at the beginning of treatment.

I knew what I had been told.

I knew what I had researched.

I knew what other men had experienced.

What I did not know yet was exactly how my own body would respond.

That story would have to be written as I lived it.

Month by month.

Test by test.

Mile Marker by Mile Marker.

That is part of why I decided to document it.

Not simply the clinical version of ADT.

The human version.

What I Hope You Take From This Mile Marker

If you have just been told that ADT may be part of your prostate cancer treatment, I hope you know that it is reasonable to have mixed emotions about it.

Ask why.

Ask how long.

Ask what to expect.

Ask what will be monitored.

Ask what your partner should know.

Ask what you can do to protect the parts of your health and life that matter to you while treatment is doing its job.

And remember that another man’s ADT story is not automatically yours.

Listen to experiences.

Learn from them.

Then bring those questions back to the people who know your individual case.

Twenty-four months sounded enormous to me.

So I stopped trying to live all 24 months at once.

I started with Tuesday.

One appointment.

One treatment.

One more question.

One more Mile Marker.

Watch the Beginning of My ADT Journey

I recorded this video just before beginning the two-year treatment plan, while the questions, concerns, and emotions were still very much in front of me.

I’m Starting 2 Years of ADT for Prostate Cancer | What It Does
Watch on YouTube

And So…The Adventure Continues.