My case study is amazingly similar; i.e. Gleason 9, Orgovyx nearing 9 months, 5 weeks/ 25 fractions- IMRT PROSTATE RADIATION and no metastasis. I am 2 months post radiation.
Orgovyx side effects have been mostly hot flashes that have now greatly subsided.
I had a sigmoid colon resection more than 2-1/2 years ago followed by a year of diarrhea. Now since radiation, the diarrhea has returned.
I am sure that my testosterone is non-existent. My testes have shrunk and erections are not happening ever. I don't even think about it anymore. I guess having no spouse to consider makes that easier.
I am 75. Not too active other than household chores and running errands to shop. I don't have a lot of energy and can sleep anytime day or night.
So overall, and by comparison to most others, I am doing pretty good. My concerns are the eventual return of colon cancer and the metastasis of my prostate cancer. It's all very worrisome.

I am curious as to the causes of the sacrum fractures? I assume that it is not trauma related?

I really want to say that your post was of great interest to me in terms of my own similarities.
But primarily, I do pray that your husband will see great improvement in all ways, including pain relief and increased mobility!
Blessings to both of you!!
PAUL

Just a few observations:

It would be unusual for "loss of use of legs" (if you mean he is paralyzed below the waist) to be due to sacral fractures. The nerves affecting motor function of the lower extremities exit above the sacrum. Does he have any fractures in the spine elsewhere? Sacral fractures can be difficult to heal but can be treated by an Interventional Radiologist doing a procedure called sacroplasty. Using CT guidance, a needle is placed into the fracture and cement is injected to stabilize the fracture. This is performed for unrelenting, persistent pain for fractures that won't heal after a few months.

The whole purpose of any ADT medication (Orgovyx/Lupron) is to severely lower the testosterone level. How long the T stays depressed is mainly dependent on: 1) patient age, 2) length of time on ADT and 3) the T level prior to beginning treatment. Older men (>70) may never regain normal (>250-300) levels of T. Once T level becomes normal, most men regain libido. It may take time, exercise etc to build bone mass if the T levels return to normal. I do not know about the anemia.

Reportedly, men tend to regain T levels faster after discontinuation of Orgovyx than Lupron.

During my 2 years on ADT (lupron, abiraterone, prednisone) in conjunction with proton therapy for Gleason 9 localized PCa with EPE, my red cell count, hematocrit and hemoglobin lowered to a bit below the low normal before a more rapid decline (along with my white count which had previously been stabe) 6 months following the time the lupron should have been out of my system. I had had swelling in my legs due to edema which, for more than a year, had been atributed to the ADT. It worsened and joint pain developed. At the same time other blood work and physiological dysfunctions began to take place. During my time on ADT, I had been out of contact with my primary care doc, an internal medicine specialist. I had the mistaken belief that the oncologist would monitor and address side effects which resulted from treatment. I finally messaged my PCP for help. Long sorry short, she reviewed my case and in short order had me tested for a thyroid issue. The test came back positive for hyperthyroidism. Thirty days after begining meds for that, nearly all symptoms have resolved, including the swelling, joint pain and all blood counts. The lesson I took from this was to remain in close contact with my PCP while undergoing onclogy treatment as there are many other conditions which might cause, contribute or exacerbate symptoms which commonly result from ADT.

You two have really been dealt a tough hand. My hope is that you are able to connect with someone who is able to find the path to address your husband's cancer, symptoms and fractures. My heart goes out to the two of you. I hope you will continue to share the story.

Bill