Hormone therapy and erectile dysfunction as a side effect is a common occurrence. Also referred to as androgen deprivation or ablation, hormone therapy is designed to dramatically reduce the levels of male hormones, primarily testosterone and dihydrotestosterone (DHT), and thereby starve the tumor. Although hormone therapy does not cure cancer, it can slow the growth of prostate cancers, or even cause them to shrink.
Hormone therapy primarily includes the use of luteinizing hormone-releasing hormone agonists (LH-RH for short) or anti-androgens, and less often, estrogens. For men who take LH-RH agonists, testosterone production essentially stops, and they will be unable to get an erection as long as they are taking the medication. Once they stop treatment, it can take 3 months to a year or even longer before they can achieve a spontaneous erection again. (Cancer Help UK)
Hormone therapy is not for every man who has prostate cancer. It is typically recommended:
- For men whose prostate cancer has already moved beyond the gland and has invaded nearby or distant parts of the body
- Before surgery or radiation in an attempt to shrink the tumor and enhance the effectiveness of the other therapies
- In combination with radiation therapy in certain men whose cancers are likely to return after therapy
- For men who have already had surgery or radiation and their cancer has returned
Hormone therapy and erectile dysfunction is an expected combination because the therapy dramatically reduces a man’s testosterone production. Although the amount of testosterone needed for healthy erectile function has not been defined, levels between 300 and 800 ng/mL are often used as a range. With use of hormone therapy, testosterone levels drop below 100 ng/mL, a level that is too low for erectile function and a healthy libido. Such low testosterone levels also affect erectile tissue.
Another factor is that during treatment with hormone therapy the muscle potentially is replaced by fat, and the flaccidity leads to collagen deposits in the penis, which in turn cause venous leakage (failure to adequately compress the draining veins from the erection chamber) and erectile dysfunction. Animal studies suggest that men who are on hormone therapy for longer than six to twelve months may experience irreversible damage to their erectile tissue. Once the tissue is damaged, venous leak results, and most men with venous leak do not recover spontaneous erections nor respond well to pills. Thus hormone therapy and erectile dysfunction may be an irreversible combination for some men.
About 50% of men who take anti-androgens alone retain their libido and erections, but they may experience erectile dysfunction with long-term use of the drugs. Only about 20% of men who take anti-androgens for a prolonged time keep their ability to get an erection.
Surgery as Hormone Therapy?
Surgery can also be used as a type of hormone therapy and erectile dysfunction will result as well. When surgeons remove the testicles (a procedure called orchiectomy), this eliminates the main source of male hormone production. This is a radical and irreversible move, which is why some men opt for “chemical castration,” which simply means taking drugs to stop male hormone production.
On the positive side, about 85% of men who have participated in hormone therapy for four to six months can expect to regain normal testosterone levels by one year after they stop treatment. The remaining 15% may take longer to have their testosterone levels restored, or they may not regain it at all.
Men who choose hormone therapy should also know that it also has an impact on libido and ejaculation, since testosterone is necessary for both sexual desire and the production of semen. About 10% of men may still have a healthy libido despite dramatically low testosterone.