Chapter 5- ScheisseChemical Castration
This chapter is not for the faint of groin
ScheisseChemical™ Castration: A Personal Journey Through Hormonal Oblivion
Androgen Deprivation Therapy (ADT) — the charming euphemism for "shutting down your body's testosterone production like a Silicon Valley startup bleeding investors" — is sold with the cheery promise of "helping control your cancer."
The fine print, however, is that it will also destroy your libido, sanity, muscles, bones, energy, and will to participate in conversations lasting longer than thirty seconds. If you’ve ever wondered what it feels like to be emotionally unstable, sexually inert, mildly sweaty, furious at squirrels, and soul-crushingly exhausted, all at the same time, welcome to the psychedelic horror show known as ADT.
This is not an experience for the faint of groin.
The logic behind ADT is brutally simple: prostate cancer loves testosterone. It feeds on it. It nuzzles it. It builds little forts out of it at night. So, naturally, the strategy is to starve the cancer by obliterating testosterone production. No testosterone, no party. No party, no cancer.
Of course, there's a small, overlooked detail: testosterone doesn’t just feed tumors. It also powers your body, mood, sex drive, muscles, bones, memory, dignity, and ability to listen to corporate hold music without gouging your own eyes out. Remove it, and you aren't just fighting cancer; you're fighting the slow-motion collapse of your entire operating system.
You get to pick your weapon:
LHRH agonists (Lupron, Eligard) — slow, miserable hormonal self-sabotage.
LHRH antagonists (Firmagon, Orgovyx) — faster shutdown, at a price that makes buying a small island look reasonable.
Anti-androgens (bicalutamide, enzalutamide, darolutamide) — they don’t kill testosterone; they just duct-tape it to a chair and gag it.
Surgical castration — quick, cheap, and suspiciously popular if you own four legs and say “baaa.”
No matter which routes you choose, the side effects come at you like a drunk marching band on fire:
First come the hot flashes, where you get to spontaneously combust in public like a malfunctioning Disney animatronic.
Then, the loss of libido: one day you’re vaguely interested in sex; the next, you’re emotionally committed to a box of bran cereal.
Erectile dysfunction follows — an experience best described as “nostalgic.”
Fatigue sets in — not "Oh, I should nap" tired, but "Maybe I'll die on these stairs and that's fine" tired.
Mood swings turn you into a sobbing rage machine over commercials featuring golden retrievers and mildly uplifting piano music.
Memory loss ensures you forget where you put your car keys, your grocery list, and eventually your reasons for optimism.
Muscle mass melts away like a popsicle in hell, while fat pads you into a human marshmallow.
Bone density goes out the window, which is perfect because you'll probably fall out of one eventually.
And cardiovascular risk spikes, because why not add heart failure to the party you're already not enjoying?
The side effects of this hormonal apocalypse are as inevitable as they are creatively humiliating. Hot flashes arrive first, ensuring you now have something in common with every menopausal woman you ever laughed at. Libido evaporates like a politician’s promise after an election. Erections become a topic best approached with nostalgic humor and fast internet connections. Fatigue sets in, but not the kind where you need a nap, but the kind where you need someone to carry you to the nap.
Mood swings add a festive unpredictability to your day, where minor inconveniences can trigger rage, existential despair, or tears over vaguely sentimental commercials. Memory starts dissolving too, making "Why did I walk into this room?" a permanent feature of life. Meanwhile, muscle melts away, fat eagerly replaces it, and your bones quietly begin planning a structural collapse. Cardiovascular risk climbs because, naturally, cancer wasn’t enough drama — let’s add a few heart attacks for flavor.
The length of your stay in this hormonal wasteland varies.
Short-term ADT usually means six months to two years , which is long enough to entirely forget what testosterone ever felt like.
Long-term or lifelong ADT is an even more perverse arrangement: the medical subscription model, with no opt-out clause and a customer service line that just plays sad violin music. Some oncologists offer the sweet fiction of intermittent ADT — periods on, periods off — but all this really means is you'll get to enjoy the side effects in imaginative new combinations.
The final insult? It works. Yes, despite its medieval crudeness, ADT demonstrably slows cancer progression, enhances radiation outcomes, and extends survival in high-risk or metastatic cases. So, we take it. Grudgingly. Resentfully. As if someone handed us a flaming bag of dog crap and called it a health plan.
There are survival strategies, of course. Exercise helps; even dragging yourself through a few minutes of resistance training can slow the muscle loss and help your heart cope. Calcium and Vitamin D supplements try valiantly to hold your bones together like overworked interns taping a crumbling office tower. Antidepressants may help control hot flashes or, more honestly, the creeping desire to smash mirrors. Talking openly with your partner is also essential, if only to give them fair warning that their life is about to become a masterclass in patience. Tracking your symptoms helps, too, if you can remember them — otherwise, just assume everything is a symptom and hand your oncologist a list.
What no one tells you until you're knee-deep in this hormonal wasteland is how much ADT warps your sense of self. Testosterone isn’t just a chemical; it’s scaffolding for confidence, resilience, sexuality, humor, even your basic tolerance for existence. When it's gone, you don’t just feel physically weaker — you feel alien to yourself. It’s not just losing erections or muscles; it’s losing the part of you that once assumed it would always bounce back.
ADT duration is a bit like being sentenced to prison by a particularly sadistic judge. Short-term (6 months to 2 years) is long enough to forget what testosterone felt like. Lifelong therapy is just a slow-motion identity erasure with occasional medical check-ins to remind you you’re still losing.
Some oncologists offer intermittent ADT, the hormonal equivalent of allowing prisoners yard time. It doesn’t make you less imprisoned; it just makes the walls more noticeable.
It works. Annoyingly, it slows cancer down. It boosts radiation effectiveness. It extends survival — sometimes by years, sometimes just long enough for you to enjoy the dazzling world of osteoporosis and depression.
Surviving it is a brutalist art form.
Exercise not because you feel like it, but because if you don't, you’ll dissolve like cotton candy in a storm.
Shovel Vitamin D and calcium into your mouth like you're building a bunker out of your own bones.
Take antidepressants to either manage the hot flashes or make existing in this cracked-out zombie version of your body slightly less unbearable.
Warn your partner — they are now involuntarily enrolled in a loyalty program they didn’t sign up for.
And document everything, because otherwise, when your doctor asks, “Any side effects?” you'll only be able to reply, “Yes. Existence.”
The real unspoken truth about ADT is that it doesn't just sandblast your body. It erases parts of you. Confidence, desire, ambition — testosterone ran those programs, and now they're throwing 404 errors. You don’t just miss erections or muscles; you miss being you. ADT forces you to mourn yourself while still being alive.
Some days you’ll rage. Other days, you'll cry at a furniture commercial and wonder who the hell you even are now. Some days, you'll laugh so darkly that small children will cross the street to avoid you.
Good.
Surviving this chemically-induced horror show isn’t about staying upbeat.
It’s about being stubborn enough, pissed off enough, and absurd enough to outlive both the disease and the treatment trying to erase you.
ADT will turn you into a different man.
Maybe one with fewer muscles.
Maybe one with weaker bones.
Maybe one who cries at weather reports.
ADT may strip you down to something unrecognizable, but it doesn’t take your will. It doesn’t take your ability to fight, to mock, to endure. And on the days when everything feels hollow and absurd and lost, remind yourself: you didn’t sign up for this.
But here you are.
Still standing.
Still swinging.
Even if it’s mostly at furniture you forgot you bought.
But still: a man who didn't fucking quit.