DEAR DR. ROACH: I am a 73-year-old who underwent successful treatment for prostate cancer, using hormone suppression and radiation in 2015. After the treatment concluded, my testosterone level increased back to 435 ng/dL, and my PSA remained below 0.1 ng/mL. I was once again able to perform sexually, although not at the same frequency I did before treatment.
In the past six months, I have noticed a dramatic reduction in my libido, much like it was when undergoing treatment. My doctor wouldn’t check my testosterone level. I understand that testosterone replacement is not recommended for men who’ve had prostate cancer because it may trigger a recurrence of the cancer. Are there any other options for me, or do I just live with it? — J.C.
ANSWER: Sexual problems after a diagnosis of prostate cancer are common, no matter what kind of treatment is given. For men who are treated with surgery, sexual troubles (most commonly erectile dysfunction) tend to happen immediately after surgery and get better over time. For men treated with hormone suppression (where medication is given so a man cannot make testosterone), sexual troubles include both low libido and erectile dysfunction, which usually occurs immediately after treatment.
With radiation, sexual troubles tend to start well after the radiation is finished, up to two years afterward. This is thought to be due to long-term damage by radiation to the nerves, arteries and other structures. Since you are well past the period of time where sexual dysfunction due to radiation is expected to occur, I’d be concerned that your testosterone has fallen, as you suspect.
I disagree with your physician about testing. Even if you weren’t going to treat your low testosterone, it is important to know why you are having symptoms. If your testosterone is low, then a decision to try testosterone replacement needs to be carefully considered. Some evidence suggests that it is pretty safe and unlikely to cause the cancer to recur, but many prostate cancer experts recommend against it. Only your urologist or oncologist can answer this for you. Most of my patients in your situation elect to try testosterone replacement.
Finally, low testosterone, erectile dysfunction, and just the diagnosis of prostate cancer itself can contribute to low libido.
There are dedicated clinics to the treatment of sexual dysfunction, and these often use testosterone (where appropriate), Viagra, or similar medicines, injection treatments and other modalities to help. Still, I regret to say that most men do not regain their full sexual function after treatment for prostate cancer.
DEAR DR. ROACH: I live downwind from a wildfire. I smelled the fire faintly when I went outside for my walk this morning. Is there a point when it’s counterproductive to exercise outside if there’s a fire, especially when it’s further away, as opposed to closer ones? We’ve had ones that made my eyes burn when I went outside; I obviously stayed inside until the fire was contained. I have been diagnosed with mild chronic obstructive pulmonary disease (COPD) and would appreciate some guidance. — L.H.
ANSWER: I recommend checking the air quality index (AQI). Many weather apps for your smartphone will give you this information, or you can check AirNow.gov. I don’t recommend exercising outside when the air quality is moderate or worse, and for my patients with COPD, I don’t recommend being outside more than you have to once the AQI is above 100. Last year, due to the large Canadian wildfires, the AQI where I practice in New York was so bad that I called my patients with lung disease to ask them to switch to telehealth visits.
