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Changes in Libido (sex drive)

What are changes in libido (sex drive)?

This refers to changes in libido or sex drive that may occur with prostate cancer and its treatment. This problem is most common with androgen deprivation therapy (hormonal therapy), which can also lead to fatigue, low energy, and other changes in the body. Hormonal therapy works by lowering testosterone levels in the body, which is the reason that it affects sex drive. Notably, even after hormonal therapy is stopped, many men are left with very low testosterone levels or at least testosterone levels lower than they had before receiving hormonal therapy. This means that symptoms can persist even after the hormonal therapy stops.

How common are changes in libido (sex drive)? Changes in libido (sex drive) are common during treatment with hormonal therapy for prostate cancer. In studies of men on hormonal therapy for prostate cancer, the vast majority of these men report lack of sexual desire. Data shows that duration of hormonal therapy is inversely proportional to libido, meaning that the longer they are on these medications, the lower their libido is.1 Men who are on intermittent hormonal therapy have improved libido compared to men on continuous hormonal therapy.1 Also, changes in libido may persist even after hormonal therapy is stopped. Changes in libido may also be seen for other reasons, such as anxiety about the cancer or other side effects from treatment.

What is the impact? Changes in libido (sex drive) may be challenging for patients and their partners. This can have an impact on couples’ relationships and may be especially challenging when libido is out of sync between partners. This is one of the main reasons prostate cancer is called a ‘couple’s disease’ as it can have a significant negative impact on couples’ intimacy.2 Libido is the aspect of male sexual functioning that is most closely associated with testosterone levels.1

How can it be treated? Libido may improve in some cases when hormonal therapy is stopped. However, this is not a guarantee and is not always possible. Patients and/or partners experiencing problems with libido may benefit from psychosocial support, including individual or group counseling, sex therapy or participation in a prostate cancer related support group (see list of resources).


[1] Corona G, Gacci M, Baldi E, Mancina R, Forti G, Maggi M. Androgen deprivation therapy in prostate cancer: focusing on sexual side effects. J Sex Med. 2012 Mar;9(3):887-902. doi: 10.1111/j.1743-6109.2011.02590.x. Epub 2012 Jan 16. PMID: 22248394.

[2] Wassersug RJ. Maintaining intimacy for prostate cancer patients on androgen deprivation therapy. Curr Opin Support Palliat Care. 2016 Mar;10(1):55-65. doi: 10.1097/SPC.0000000000000190. PMID: 26761788.


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