For Newly Arrived Bros: A Day In The Life With ADT

Posted by hans_casteels @hanscasteels, May 24 11:24am

Gentlemen, gather 'round. You’ve just joined the club. Not by choice, of course, nobody fills out a loyalty card for this one. No, you were drafted into the Great Prostate Parade, handed a pamphlet with clip-art prostates and words like “treatment plan,” “Gleason score,” and “androgen deprivation therapy,” and then politely pushed off a hormonal cliff. The pamphlet, if you remember it, featured two suspiciously cheerful mature adults riding a tandem bike through a tulip field in Ottawa—because nothing says “chemical castration” like a leisurely spring ride near the Parliament buildings. He’s wearing khakis. She’s wearing a pastel sweater. Neither of them is crying, sweating, or yelling at a toaster. Clearly, they’re actors. Or on drugs. Probably both.

Welcome to the next phase of your life: ADT. The doctors will call it “testosterone suppression.” The brochures will say it’s “generally well tolerated.” And your oncologist, with the calm detachment of someone who still has their own hormones, will inform you that it’s a necessary step. What no one tells you, at least not until it’s too late, is that you’re about to become a walking biology experiment with the emotional stability of a raccoon in a washing machine.

In this episode, I’ll walk you through what a typical day looks like once Firmagon (or Lupron, or any of its chemical cousins) has declared martial law on your endocrine system. Expect night sweats. Expect hot flashes. Expect to tear up at car commercials. And above all, expect to be told, repeatedly, that it’s “just temporary.”

That was the brochure version. Spoiler: it’s not temporary enough.

But don’t worry, brother. You’re not alone. You’ve entered the weird, wild, sweaty world of Firmagon Man—and this is your survival guide. There are superheroes, and then there’s Firmagon Man. Unlike your typical caped crusader who gets their powers from radioactive spiders or military-grade gamma rays, Firmagon Man gets his from a 4-inch needle jabbed into his belly fat by a smiling nurse named Janet, who cheerfully announces, “This might sting a bit,” right before plunging you into menopause. Yes, menopause. The one they never warned you about in Boy Scouts.

6:00 AM: The Awakening

I wake up in a lake. Not beside it. In it. My sheets are soaked. My pillow is a sponge. My pajamas cling to me like desperate polyester. A hot flash, they say. More like spontaneous human combustion. I strip down like a drunk wizard shedding dignity and whisper a quiet curse to the gods of endocrinology.

I stumble to the bathroom mirror to confirm that yes, I still resemble a damp, middle-aged raisin with slightly less testosterone than a vegan housecat. My testicles have gone on a sabbatical. My chest is developing the soft swell of early motherhood. I weep gently. Or I would, but I’m too dehydrated from last night’s sweat tsunami.

9:00 AM: The Coffee Incident

Caffeine is supposed to help you wake up. Unfortunately, in Firmagon Land, it’s the equivalent of lighting a match inside a furnace. One sip, and I’m sweating like I’m being grilled by Homeland Security about undeclared hormone levels.

My wife watches me with mild concern and slight revulsion. “You okay?” “I’m great,” I pant, fanning my armpits with a cereal box. “Just experiencing internal global warming.” She nods. She’s stopped asking questions. There are no answers. Only hormone suppression and the vague scent of burnt toast.

11:30 AM: The Mood Swing

Something small happens. A bird chirps wrong. Someone uses Comic Sans. I burst into tears. Not soft, movie-tears. No, I sob like I just watched a puppy get denied bail.

Then, moments later, I feel fine. Euphoric, even. I decide to reorganize the garage, write a memoir, and start a podcast about glandular injustice. By noon, I hate everyone again and abandon all plans, except for the one involving a nap and some light cursing.

2:00 PM: The Great Nap and Post-Nap Identity Crisis

I nap for exactly 14 minutes and wake up in 1963. Or at least that’s how it feels. I'm drenched again. My shirt could be wrung out into a mop bucket. My dreams were vivid, mainly involving ice baths and revenge.

I stumble to the fridge, open the door, and just stand there, basking in the cold, whispering, “Yes. This is the way.” I consider moving in. There’s ham in here. And peace.

5:30 PM: The Attempt at Exercise

In a burst of misguided optimism, I go for a walk. Three blocks in, I’m a human lava lamp. Everything hurts. My joints feel like they’ve been swapped for mismatched IKEA hinges. A small child jogs past me and says, “You okay, mister?”

“No,” I reply. “But thank you for asking. You give me hope. Sort of.” He offers me a juice box. I cry again. He runs away.

6:30 PM: Cooking with the Castrated Chef

Tonight’s menu: grilled salmon, steamed vegetables, and whatever residual dignity I can find in the pantry. I approach the stove like a man on a game show where the grand prize is another hot flash. The moment the burner ignites, so do I. I am suddenly basted in my own sweat, seasoning my food with droplets of hormonal despair. The salmon steams, I steam, the kitchen becomes a sauna with cutlery. I stir rice while muttering Gordon Ramsay insults at myself: “It’s raw, you soggy bollock!” My wife wanders in, sees me glistening like a ham in church, and backs out slowly. Dinner is eventually served, though I can’t taste anything through the haze of thermal misery and low testosterone. Bon appétit, from your Michelin-starred eunuch.

8:00 PM: Intimacy, The Concept

My wife puts on that silk nightgown. The one that used to mean something. I feel... absolutely nothing. Not indifference. Not affection. Nothing. My libido was taken out back and euthanized during my last injection.

We cuddle anyway. And by cuddle, I mean she lies near me while I radiate heat like a malfunctioning nuclear reactor. She says, “You’re very warm.” “I’m basically a fever with legs,” I reply. “A sexy, barren heatwave of doom.”

10:00 PM: Nightfall and The Return of The Boil

As I lie in bed, awaiting the inevitable midnight flash flood, I reflect on my day. Cancer treatment, they said. ADT. Just a “little chemical castration” to keep those PSA levels down. No biggie.

Except now I’m a sweaty, moody, neutered vigilante in loose sweatpants, fighting the slow hormonal apocalypse with sarcasm, Gatorade, and seven strategically placed fans. Some men get bat signals. I get hot flashes. And I handle them like a man. A very damp, mostly hairless, emotionally unstable man.

Firmagon Man. Saving the world, one hormonal collapse at a time.

Interested in more discussions like this? Go to the Prostate Cancer Support Group.

Ty for your response - good health to you - Gary

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Paul - one last thought - did you ever consider - intermentent therapy with the - adt ?

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Hi Hans, Very entertaining piece of writing if not so tragic. If Firmagon causes those reactions you should talk to your doc about Orgovyx, a relatively new form of testosterone deprivation. I’m taking it coupled with Nubeqa.
FYI: Was on Lupron for two years relatively free of side effects other than Gynecomastia, body hair loss, and perhaps a little fatigue. Good luck.

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I applaud you for finding the ability to write humorously about your misery. And "thank you" for the warning of what ADT is like for what is "most men" (any guys out there want to contribute anything different and less intense?). And...
I am curious about your timeline and interventions as follows:
1. When were you diagnosed with prostate CA?
2. What was your PSA at the time of diagnosis?
3. What was your Gleason Score at the time of biopsy?
4. What was your Decipher Score whenever you had it done?
5. When was your radical prostatectomy, assuming you had the surgery?
6. How many months and years were your post-op PSA tests "zero" (< 0.1 ng/ml)?
7. Did you do radiation before or with ADT?
8. When did you start ADT?
9. How long were you on - or how long do you have to be on - ADT?
Thank you

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LOL
I'm about to embark on 6 months of Lupron. I hope I can my sense of humor as well as you.

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