I did 28xIMRT + Camcevi (Leuprolide) and I'm as happy with my decision as you can be with two awful choices. I had my last shot in December and my Zitiga is running out in 3 weeks!

The most common comments I read here about RP are about what I thought when I researched and personally I'm happy not to have chosen it. The IMRT/ADT approach is definitely not a walk in the park and is also very likely to have sexual side effects. In my experience these are barely mentioned in the original Doctor meetings which probably shows just how likely they are.

As an aside, my (youngish) Radiologist (who I met first) recommended IMRT/ADT and the (older, very experienced) Urologist recommended RP. He also dissed her experience a little. For my second, pick-one meeting with him I had firmly decided to go with her recommendation and I went to him prepared with a lot of information and statistics. He walked in and after the preamble, said: "I think, in your case, we should go with radiation..." I laughed and showed him my now unnecessary preparation notes.

RP is certainly very immediate and afterwards you are effectively "cured" but the effects are nasty and I keep hearing recurrence stories on here (comparison statistics must be easily available but I haven't looked). I know if I have a recurrence my options will be much more limited but I'm ignoring that for now.

I laugh at myself and talk about my 2 years [chemically] identifying as a woman. It really has given me a lot of insights that I didn't have before. Sexuality is very strange, I still love women (and I have a new, super-understanding girlfriend) but you simply don't get that familiar chemical reaction to sexy situations. Seeing a hot girl isn't hugely different to me as seeing a very interesting car - but I do like cars 🙂

We're waiting patiently for my T to come back and I'll do whatever it takes for a practical approach to penetration. But our sex life has been excellent, rewarding, frequent, and lengthy even if it is 95% concentrated on her for now. From right here right now, I feel like penetration will be a bit of a side show when I do manage it. Her pleasure is very rewarding to me (and it is the number one thing that will lead to a 3/4 Viagra erection) but it's a little detached as if she was really enjoying something I had cooked for her.

Knowing that there's a 99% chance I will never ejaculate again makes me sad (that was never mentioned in my doc meetings nor did I find it during research) but I will adapt and there will be all kinds of benefits for ease of clean-up 🙂 I am also hoping to be multi-orgasmic as is sometimes reported here.

No-one can really help you with this decision. It will be full of your and our conformation bias. Good luck!