As many of my readers already know, I was diagnosed with metastatic prostate cancer last November.
I have done very well with my PSA going from 6000 down to 0.5 in 5 months and for this I am truly blessed. It is up at 3 now, so after conferring with my medical team, I will be undergoing Provenge therapy which is an immune therapy where my T cells learn how to kill those scattered cancer cells that must still be there.
Before starting the immune therapy, I can say I have been active, staying on top of taking care of myself and even started dating a few months ago. Perhaps this sounds crazy during this COVID nightmare, but it has been very interesting. In fact so interesting, I have some thoughts I want to share about the impact of hormones on dating and sexuality that have come to define my American male identity.
My hope is that by sharing my self-reflections (as a patient) on the unexpected social benefits of hormonal change, my insights will assist men with prostate cancer who are debating whether or not to include hormonal blockers in their therapeutic treatment plan.
As a physician, I also want to help men suffering from prostate cancer, especially those in their 60’s and 70’s, consider the life saving benefits of hormone therapy, knowing they can proceed with happy lives, even if they lose their sex drive.
How is that possible?
Questions to first ask yourself
Men, let’s face, from the standpoint of animal evolution, we are not supposed to live this long. But we have and the consequences of our testosterone drive life span play out in the dire reports of inhumanity dished out by 24/7 news cycles. From teenage predation to damaging football concussions, from office competition to the bravado of crushing world market opponents, our testosterone saturated brains appear to drive our minds into acts of aggressive and often unhinged decision-making.
But what if….
What if at post procreation, a man’s testosterone dropped to statistically significant low levels. What might be different? Everything would be different. Congress would have 4 pm tea (and actually get something done.)
What if at post-procreation, a man’s testosterone level fell to levels where sex were perhaps possible, but not a big deal?
What if at post-procreation, a man’s testosterone numbers spontaneously reduced so our brains started to value peace, not war, collective collaboration not self-gratifying competition. What if our feelings intertwined with thoughts? Men, if we listen to neuroscientists like Antonio Damasio, our feelings are intertwined with our thoughts. Driven by testosterone loaded brains, we just don’t like to admit.
Stop and consider the actual benefits of lowering testosterone. Create a pro-con list. You just may begin to see the benefits outweigh the loss.
And dating? At the age of 70, sex is different anyway. More on that in a bit.
What I Discovered
I’ll start with the honest truth of my “testosterone storm” from age 14 to 69.
Sex, Sex Sex. I framed all of my female relations as a social contract of sex and identity. By that I mean, I realize this hormone affected my masculine identity and sexual behaviors to such a degree that it set about wreaking havoc on all of my female relations -- from friendships to two marriages. Looking back across five decades, I now cringe.
Perhaps what makes it worse, I think back on my medical education training and realize that we were taught about testosterone and its behavioral characteristics but those teachings did not move the needle of sexual obsession even an inch.
Now 70 years of age, I still have all the same sexual thoughts, but I have lost that trigger. I lost that sexual spark, the scent of the hunt… instead, I’ve started to feel, well, more like what I imagine women feel like. Or to put it another way, I have changed my filter of how I view women. I now tend to see the situation women are in from a different point of view.
Now I know some of my female friends will jump to correct me, but wait, what do I mean by imagining how women feel? I mean, if I look into the mirror to account for my motives, I can honestly say to myself that nearly all female interactions have changed for the better. I feel as if I am acting as a better friend, a colleague and as a lover and it seems my efforts have not gone unnoticed.
My current self-assessment:
*What do I mean I have come a real feminist? Point blank, I know how women have gotten the short end of the social contract, from lower paychecks to being expected to fulfill our every desire. I now see how women in medicine, from the time I was in medical school to even today, are typically steered toward family medicine and away from surgical residences based on the unconscious, testosterone laced bias of male leadership.
What I am saying is that “hard truth” revelations that come with prostate cancer hormone therapy have led to a rude awakening of my identity as a male and a change for the better in my behavior. The benefits are outweighing the costs.
More Happiness or More Sex
So as I mentioned at the outset, I am dating again. For sure, I have learned that I now cherish those old fashioned phone calls and love letters. There have been occasional “safe” and distanced meetings. I once held hands with a woman, but we both immediately sanitized our hands. Perhaps not the most romantic thing in the world, but it was romantic for me. Who knew??
More importantly, my new revelations have led to taking full stock of my psychology life. Post-prostate cancer, I ask myself, what matters? What makes me happy?
Here’s what I’ve noticed:
Men -- life throws us challenges and prostate cancer is no joke. The medical threat to our bodies, our identity, our sense of masculinity, our lives is serious and deserves consideration of all the options before us.
Today, we must join with scientists and teenagers (our younger selves) in discovering the hard truths of hormonal change.
Today, we can find a happy life after prostate cancer.
I write this to encourage you to look the truth in the eye, feel the threat to your sense of manhood and take time to notice what feelings arise. If this feels insurmountable, talk to someone. Talk to me.
Of course, younger men and for many others, I realize this sounds a bit nuts, but for the right man out there, please think about it. Prostate Cancer Hormone Therapy is not the end of the world.
It is the beginning of a new and probably improved you.