By Timothy

I’ve been on androgen deprivation treatment (ADT) since March 2024 – I’ve had literally no testosterone in my body for more than a year and a half. Yet it is important to me to remain sexual no matter what.

Being on ADT, it often feels like pleasure and orgasm are on the other side of a sheet of glass. I can see them but I can’t quite reach them.

When I first had my testosterone taken away by ADT, I could still orgasm for the first few weeks.  Then I just lost that ability.

I cried for two weeks. Here’s how I responded over a longer period.

Estradiol supplements as alternative to conventional ADT

Once I learned about the large scale clinical trials of taking estradiol (female hormones) as an alternative to conventional ADT, I took practical steps to find a doctor who could help me access this treatment. I have been taking estradiol supplements since December 2024 and it has been a very positive experience.

With estradiol in my body

• My mood has been much more positive
• I have the libido of a pre-menopausal woman
• I have been able to reclaim regular orgasms
• Hot flushes are much less intense than on ADT alone
• Bone density tests indicate no losses (a common side effect of conventional ADT).

Mindset shift: identifying the positives of ADT/estradiol

I’m not denying that ADT took away a lot that I loved. But there have also been gains. Firstly, I feel I have never been so wholly giving of myself, so honest and so caring as I am today in my loving. Simply put, I am closer to my wife and I’m a better lover and this makes me happy.

And shifting my mindset further has helped me adjust to my new reality. Here are seven more good things that have happened in my life since I started on ADT:

• I have stopped drinking
• I lost 30 pounds (14 kg) in weight
• My skin is softer and nicer
• There is more hair growing on my scalp
• I actually like my man-boobs, and they enjoy touch (although sometimes it’s painful)
• Regular exercise has become my norm
• It feels good to embrace my new emotionality.

The symbol you see in the image at the top of this post might help you understand my experience and my gender identity, which I find now to be liminal in nature.

Outcome so far: sustained sexual pleasure

At the time of writing, I am back to regular sexual self-pleasuring. My orgasms are much like they were before treatment started. Dry now, of course, but with plenty of Cowper’s Gland secretions (precum). It takes a lot longer to have an orgasm but I find as the days go by, I feel an urge to come. It helps to engage with my partner regularly in loving ways. I have to be prepared for some climacturia but that doesn’t bother me because it all feels so good.

Emily Nagoski sums it up well for me:

When you embrace your sexuality precisely as it is right now, that’s the context that creates the greatest potential for ecstatic pleasure

– This quote is from Come as You Are by Emily Nagoski. See also What men can learn from Emily Nagoski’s book.

For more about Estradiol as an alternative route to ADT

See the Estradiol Iniatiative, which has a mission to expand treatment options for men undergoing Androgen Deprivation Therapy (ADT) for prostate cancer.