Not able to have a orgasm

It could be the drugs you are on could be causing the problem. I found that when I was on Zytiga the prednisone, made it very difficult to reach orgasm.

What drugs do you take?

I cannot reach orgasm anymore after four months of ADT. I found a study from Memorial Sloan Kettering: "ADT results in significant orgasm dysfunction with loss of orgasmic capability in all patients with time and reduced intensity and increased IELT in all. Patients undergoing ADT should be counseled regarding changes in orgasm."

I'm hoping this ability comes back when I'm done with ADT in ~50 more days.

Good luck and hoping you will be able to return to normal after the ADT. I'm not on any meds at the time but the future may bring that about. Having a visit with my new urologist on Wednesday. I have a lot of questions for him. Thanks for your response.

How long post surgery or radiation are you? Which treatment did you choose?

I had a radical prostatectomy in 2008. I had recurrence prostate cancer in the prostate bed in 2011 and had 36 treatments of proton radiation with 6 months of hormone therapy. I don't know which hormone was used. Since I have been having PSA checks every three months with continuing PSA rise. I'm due another test Wednesday. Last time it was 4.8 which was a minor decrease from the previous test. I've had 4 PET scans and so far they haven't detected any cancer. So, I'm on a wait and see.

I’m a little surprised that they are letting this go without discussing putting you on hormone therapy. The rule is, after radiation, if you have three rises in your PSA it’s time to start hormone therapy. You are at 4.8, have there been 3 rises, even if it has dropped recently?

After a prostatectomy radiation is recommended to be started when the PSA reaches .2. How high was yours allowed to go before they started radiation?

It was about 2.8 if I remember correctly. Part of not beginning hormone therapy is my decision. After 4 PET scans and there is nothing detectable, I have elected to not treat something they can't see. Yes, it's risky but so is driving a automobile to my urologist appointment.

This is a very personal decision for each patient. Due to my HYPOGONADISM for the past 13 years, I’ve been on “TRT” TESTOSTERONE REPLACEMENT THERAPY. Without it, I would be mostly bedridden and home confined, with no sex drive and unable to do much of anything. Unfortunately, I’ve also been severely debilitated from CHRONIC FATIGUE SYNDROME and FIBROMYALGIA for the past 33 years. Without utilizing “TRT” I am practically dead anyway without any quality of life. If my cancer returns, I will probably seek radiation therapy of some kind or combination thereof. However, I won’t be utilizing LUPRON or anything like it. I certainly don’t have a death wish but in my life, I’ve already been on the doorsteps of death a handful of times and I am not going back to that. Certainly not by choice and or by discontinuing my “TRT” and utilizing LUPRON. I choose to live the highest quality of life I can until mine is over, PERIOD.

Yes, I can see how it's a difficult balancing act. Elimating testosterone slows or stops the progression of prostate cancer, but it increases the risk of heart disease, diabetes, anemia, osteoporosis, and other dangerous conditions.

I just counted, and my oncology team is actively monitoring 30 different blood tests for me. Obviously PSA is the Big Number, but the others indicate how well I'm tolerating the treatment that's keeping my PSA undetectable (in addition to various imaging tests).

Yeah, @harvey44 sometimes I'm not even sure I had an orgasm! Mainly I find out that the anticipation phase has passed and does not return, so whatever I had, that was it. Sometimes it's better than others, but it is never like before PC. Over the last 2+ years I've coached myself to accept whatever is, try whatever helps, and enjoy who I am. One thing is for sure, I don't have any trouble with premature ejaculation :-).
Now, what have I read? Not much that directly addresses this. But what does suggests this is normal, and part of it is definitely in the brain, not the tissues. However, it is also apparently normal to require more or different stimulation to reach climax than previously. This in turn I find means that it can be harder on the physical parts and I find that may require more recovery time. (Makes sense to me, given nerve damage, trauma, and/or retraining)
@philipsnowdon I've wondered if I'm low testosterone, and my urologist is willing to explore this, but I don't have your challenging history, and I've been reticent to consider testosterone for fear it might feed the (currently latent) cancer which I assume is still lurking somewhere. Maybe if I'm still stable in another 5-10 years? One day at a time.
As of now, I haven't had sexual intimacy using a pump and ring, although I've tried self stimulation with this combination to learn. Based on this, I think this would be different, but not necessarily preferable. I was using trimix, but my wife found it inhibiting because the arousal was so immediate and the injection process was not itself pleasurable or intimate. I found that while I had a firm erection, it also led to more discomfort or even painful tenderness, so we switched to accepting hardness insufficient for penetration for a while and now we have added sildenafil (viagra) which I wasn't able to tolerate earlier because of side effects, but seem to be able to tolerate now. With sildenafil 100mg arousal is maybe just good enough (6 on a 10 pt scale?) It's been about 2 months since we last used a trimix injection.