Update 2 yrs since Dx - Can we talk about S-E-X?

Dx 12/29/21 GS8 or 9, depending on whose opinion you go by.
Opted for Proton RT at Siteman St Louis Mar-Mayy 2022. 44 tx. Also started Eligard- 3mo injections. Zytiga added June 2022.
ADT was horrible. Zytiga discontinued Feb 2023 after having minor stroke. Sept 2023 discontinued Eligard after 18 months (24 mo had been original plan). First PSA, 90 days later (last week) was undetectable. YEA! Testosterone up to 17 (haha). Libido still undetectable. I guess that is "As Good As It Gets" for right now.

Biggest concern is I still have the Brain Fog. CRS. Things just do not "click" as they used to. Is this typical after 3 mo off of ADT? Or, I have a slight concern it may be from the minor stroke in Feb though CT/MRIs left the "cause" of the "stroke" inconclusive. I also have a higher anxiety level than ever in the past. This I blame on no testosterone.

Second concern: I'm sure the almost no testosterone is to blame for the lack (actually total absence) of libido. At risk of TMI - while always a "grower", I am about half the man I used to be. Shorter. Smaller. Likes to play "turtle". Think pre-puberty. Will this improve? I was on TRT for 30 years as I had extremely low test. at 35yo. so I do not expect it to ever rise to "normal" on its own. Speaking of "rise to normal", I have had rare (disappointing) erections. Attempted intercourse once without success. Sure, some of that is likely psychological, but not entirely. Daily 20mg Cialis does nothing.

So, is this where I ask for advise/experience about using pumps &/or injections? (OUCH!).

Perhaps I should add, I'm 68 yo and not very active as far as working out, etc. but after discontinuing the ADT I have again tackled some things around the houses that I had put off. I like projects. My wife is 5 years younger and my "trophy" wife of 45 years. (Yeah, I'm a lucky dude.) She has her health issues too (Type 1 diabetes, just had 3-way CABG) but doesn't like celibacy either.

If I can't ask this here, where would I go? All the young docs think at 68 you should be eating oatmeal and applesauce and watching Matlock for excitement. (I do realize I'm fortunate to have these concerns vs. spiking PSA, etc.)

Thanks!
Hoping 2024 ushers in only good things for all!

1st Serious, it took over one year after finishing 6 months ADT for my Testosterone to return to baseline levels, which weren't that high to begin with, at 320 ish.
I have to admit, while I have my libido back, it aint quite what it used to be. I am 72, so I've just come to accept it. Everyone is different

Just my opinion. Not medical advice just information for your consideration.

Following RALP in 2017, I went through same mental gymnastics hoping "nerve sparing" would result in maintaining erectile function. Tried PDE5s, VED and injections. Drugs caused blurry vision, sweats and headaches. For VED, had to use severely tight restricting ring which impacted any ejection, caused lack of feeling and short usage time. Plus, had to stop and pump. Used bi, tri and quad mix. All I achieved was short term 50 percent useless erection and severe pain and burning. Decided in 2021 to undergo penile implant which was delayed due to world events until 2022. By that time I had lost size due to atrophy caused by not pumping daily to achieve oxygenation blood flow to penis and had severe scar tissue buildup. This with development, which I attribute to injections, of dorsal PD curvature. To correct the PD my surgeon performed a plication, which by its nature results in loss of length.

To date, I have had initial implant and one revision. I had no complications from implant surgery or recover. Once cleared "for action" it's amazing. Wife and I enjoyed ourselves the other night and the following morning she woke me up for a morning delight! It may be scary thinking of cutting down there but surgery is surgery. It's a personal decision and maybe not for everyone. But it is an option to consider. Would I do it again? Most definitely. Any regrets? Yes that I didn't do it sooner.

A site mentioned before, addressing implants, is franktalk.org.

Hope I didn't step on any toes. Like I said, my opinion from my experiences.

Regards to all.

Isitserious, looking at your data it shows you are @4 months out from stopping of ADT. Obviously, you know the side effects of ADT linger in your system for months, if not years, after stoppage. No one can tell you how long it will take to clear your system, so mood swings, depression, hot flashes, etc will presist to some degree. What I would stress is that you take whatever means is suitable to you in order to address penis health. You must maintain a good flow of oxygenated blood through your member in order to avoid atrophy and other complications. PDE5s and VED usage is beneficial. When "T" returns and you start feeling the urge everything available may be worthless with an ignored penis. Research the issue and decide. It's your personal decision. Best of luck to you. Rgds

I guess everybody has their own opinion. I'm an old man. Of course, my libido is nothing close to what it was when I was a young guy. I figured God designed it that way, and when I put some logical thought behind it, for darn good reason from a biological standpoint. It makes perfect sense. For me it's actually a blessing when I think of all the time I spent finding ways to get lucky. I thank God for taking some of that away so I can devote what time I have left to more meaningful endeavors that offer as great a joy at reduced risk. Some say we don't know what we had until we lose it. Well, that may very well be true in some instances. But sometimes life has a way of opening up new doors and all we have to do is walk through. The journey is a great one as long as we accept our limitations as we move along.

Extended "ADT" killed 1 testicle and severely injured the other (also screwed up my lungs, among other things). Started with T of 750, dropped to 125. Surgery & radiation shrunk my asset. Pills did nothing - total ED and no libido. Still use the pump once a week for blood flow and to avoid Peyronie's. I would have to use the pump and 2 small rings to give myself a shot. Not happening.

At this point I am "here, now" (accepting my limitations), and as the Buddha advises I appreciate what I have and choose not attach to what I do not have. My young wife of 32 years has lost interest and her girl parts no longer work. Like Jane Fonda she has 'closed up shop down there', so she says she would have to do something extraordinary if I recovered my interest in such things.

After all I have gone through to try and get rid of my cancer, no way would I up my testosterone and maybe encourage any stray cancer cells that remain. Those blood test zeros give me much more satisfaction than sex ever could. There is indeed life beyond sex, and it is pretty good, actually.

EDIT: insurance paid for the pump - $500 - as it is a "durable medical device". Still works fine 12 years later.