Episode 139: The Male Menopause - One Man's Journey post Prostate Cancer

This week's episode has been sponsored by Oh My Bod, shifting the evolution of pleasure. Hi, this is Suzanne Noble, and you're listening to Sex Advice for Seniors. Today I'm doing something actually that I've never done before.. And that is I'm actually talking with somebody that follows me on Substack and on this podcast. And I don't know if I was the inspiration for this, Bob, but you've started your own podcast, your own Substack now called A Man Paused. Get the joke? Well, we'll all talk about the joke later. Bob, Bob Mizek. And welcome, Bob, to Sex Advice for Seniors.

Well, thank you. I'm honored to be on your podcast. You're a fantastic writer. I enjoy reading your stuff and listening to your podcast, and it's an honor to be here.

Thank you so much. And the reason— and the reason why we're chatting is because I've spoken to, you know, quite a lot of— mainly, if I'm really honest, medical professionals, urologists, people like that— about issues around male sexual health and sexual function. And you started writing to me and we started having a conversation and about your own journey as a man who, who's had prostate cancer and then went through surgery as a result of that. So, you know, can you just tell me a bit about that, about, you know, when this— when you found out what happened?

So, so, um, this is my second go-around with prostate cancer. Uh, I first had it in 2020 and I had the radioactive near-field radiation seeds and we thought we had it licked and I chose that because you maintain a good sex life and continence and all this other stuff unfortunately didn't work and became raging back in 2023. I've had salvage surgery, have had salvage radiation, and now I'm on Androgen Deprivation Therapy so— I have less testosterone than you do Susan!

Well, I'm going to get my testosterone tested on the 30th of March. So we'll see about that. I don't know. I suspect I've still got some, but who knows how much. So how did the diagnosis and the treatment impact your perspective on intimacy and relationships?

Well, my surgeon basically told me that after treatment, it was 90% likely that my sex life would be over. And I was terribly distraught over this, and I lost perspective that true intimacy could indeed survive ED. And, you know, intimacy is an important and strong part of what makes a good relationship. And with the patience and the right help, both sexual intimacy and non-sexual intimacy can both thrive.

Yeah, I mean, What we spoke a little bit before we started about the fact that often when men undergo surgery for prostate cancer, their doctors don't really talk to them about sexual function. Were you in that camp?

Well, my doctor told me that it was highly unlikely.

That it was over, right?

Yeah, it was over. It was over. And you want to see terror in the eyes of a surgeon? Or a medical oncologist, ask them, okay, so what can we do about this? I'm not really happy with that. I've had a really good sex life for 68 years. Well, not 68 years, 'cause some of that was as a kid, but my point to the matter is I'm not ready to give this up. So, you know, what do we have to do to keep me in the game? And you get that cold stare like, oh shit, now what are we, now how am I gonna answer this? 'Cause they're not trained in this. They're not trained in this. You need to find a specialist.

Yeah, yeah. And a lot of people, I suspect, and I mentioned to you a friend of mine who's going through this, they just are traumatized. You know, I mean, for somebody, first, obviously, when somebody tells you you have cancer, it's horrible. I can't even imagine what that's like, right? But then on top of it, to go like, oh, and by the way, your sex life is over.

It's like, it's a lot. It's two things. It's one to be told, and then it's another one that happens because, you know, quite honestly, sleep. You know, I, I was in athletic shape, you know, before surgery and everything. I had really good blood flow, so I had like no ED. And it went from no ED to no anything, you know, to totally D. And it was heartbreaking. It was absolutely heartbreaking. And, and I thought, I'm not gonna— I'm not gonna settle for, for a life without intimacy. So I made it my mission to live my best life. And that's one reason I'm on your podcast, to maybe help others live their best lives.

Yeah, so let's, let's talk a little bit about that. And we can talk about the androgen deprivation therapy after that. But I'm curious to know, so you said to the guy, right, what can we do about that? And he looked at you in shock and horror. And then what happened after that? What have you tried?

So, so what, so what I did was, first of all, I tried on my own, I tried a vacuum erection device. And it was so painful, I would have given the nuclear launch codes for it to stop. And I'm the one doing it. Right.

Right.

So, so that, that didn't work. Okay. And quite honestly, before, you know, and this is like TMI, but come on, we're all adults here, right? So before, before radiation, after surgery, I was kind of halfway there. He was able to preserve the nerves on both sides and the nerves that control erection. So, so things looked pretty good. Then, you know, the The train came off the tracks because of radiation and androgen deprivation therapy. So finally I came back to him. I said, come on, you got to know a guy. And he, and he, and he gave me a referral. And so I've been going to a urologist that specializes in men's sexual health and I'm doing penile injections and they're working great.

Oh, right. That's amazing. And do you self-administer those?

Oh yeah. Yeah. It's, you know, it's, it's It's kind of funny because when I first heard about it, I'm going, oh, I'm not going to do that. And then you go and you do it and you realize it's just a little prick. Oh, shoot. That's probably not the best word to use. It's just a little pinch and it's over in a few seconds. And, and, and you don't think about it. You know, there's a right way to do it and a wrong way. And, and I think it's kind of onerous to ask your partner to do that. So you do it and you get on with fun.

Yeah, because I know a sexual health nurse that I've interviewed on the podcast, and she does that for men. But of course, that's difficult because there is a time lag. But then, you know, you have to plan the whole thing, right? You have to go and see a nurse, and then she does, and then there's like, I guess, and then she said that often they just go into the toilet, you know, do what they want to do with that. But, but it's much better if you can, if you can learn how to do it yourself. For me, it's sort of because I'm a bit scared of needles, it kind of freaks me out. But I can see that it, you know, it works, right? What about things like Viagra and Cialis? Are they just—

Well, once I'm done with androgen deprivation therapy, it's— I should not need injections anymore once my testosterone comes back. So, so at that point, you know, I've been told by my surgeon, whom we've had, you know, good, frank talks with since, he said, you know what, I don't— I think you're going to be fine. And I've got till November 1st and then I can get off the drugs, get my testosterone up and maybe something else too.

Oh, brilliant. And you mentioned in your, in your Substack that you really related to what women go through with menopause since you've been on this therapy, this androgen deprivation therapy. Tell me a bit about that. Like, so what are How do you feel?

I have every— Excuse me, I'm sorry.

Do you get moody?

Oh, are you kidding? I have mood swings. I have mood swings. My wife Pam, she is terrific. She helps me through this. But I, I have every symptom pretty much except vaginal dryness. Okay. For obvious reasons. Okay.

Yeah.

So, but, but the worst is hot flashes. So before I came here, I went to the health club and I have probably more than the average menopausal woman. I have 20 to 30 a day.

Okay.

And they're unbelievable. They're just unbelievable. And I was in the— I was in the whirlpool tub. It's 101 degrees and I got a hot flash. I felt like a lobster cooking.

So, no, that's terrible. So you get the whole thing right. The The water dripping down your back, the water dripping off your face. So Bob, you're not wearing layers. Like menopausal women know the key to hot flashes is layers, right?

Right.

You start off with a light t-shirt underneath, then you put the shirt on top. Then if it's really cold, you wear a sweater. And then when you get the flash, then everything starts coming off. That's the way it works. What's wrong with you? Don't you know that?

I'm learning. I'm learning. So, so just a quick side note. So I'm, I'm learning to fly a different kind of airplane. It's real little and I'm wearing a jacket, right? And we're like, I'm pilot in command. We're at 4,000 feet and I got a hot flash and the plane is so small I can't take off the jacket. So sweat's running down me. You know, it's just, you know, so, so my point of the matter is, is I feel for women who go through this and there's help for them. Okay. You know, you can do systemic estrogen, maybe a little progesterone. It can be in a gel form. You know, it can be oral. It can be things like that. I don't have those options. I've just got to suffer through this. But I'm going to make it my mission to help educate men so they can support their partners when they're going through any stage of menopause.

Yeah. So basically this situation that you're in is for the entire length of your androgen deprivation therapy. And after that, basically your levels, your levels start rising again naturally, or you can then have, or you're then taking testosterone?

Well, hopefully my testicles start working again because that's where the majority of testosterone is made. If they lag behind and I'm cancer-free for a year, then I can get testosterone injections.

Oh, right. Okay. Yeah. I know someone who's giving their wife those and she's really enjoying it.

Well, you know, it's funny because one of the side effects of low testosterone is low libido. And I still got some, obviously, otherwise I wouldn't be on your, on your podcast.

Yeah.

But, but the fact of the matter is, is is testosterone does a lot of things with bone health and also libido in men and women. So you're spot on.

Totally. And, and you know what, there's, um, I don't know if you know Dr. Kelly Caspersen. She's a big proponent of giving testosterone to women, right? And just about hormone therapy in general. And there's a lot of resistance again in the medical profession amongst giving testosterone to women. Lots of it. And she's really, she talks about the, all the benefits in terms, just as you've described bone health. Just if you're a woman that does strength training as well, it increases your muscle mass. It obviously improves your libido. The guy I know that, that is a doctor that, that provides his wife with it, she— he said that the, that the pill form or the cream form is— he debates how effective it is, but I know that Certainly listening to Kelly, there seems to be an impact in giving women testosterone. And, you know, it's again one of those things I think where— because my friend takes it who's like in her early 70s, and she said it's amazing, but she had to really fight for it. And I think what I've learned again is that with all of this stuff, you gotta really demand, demand it. You got to say, I don't care what your personal beliefs are around this. Like, I want this stuff.

And you have to be your own advocate. You're spot on, Suzanne Noble. I agree 100%.

You know, totally. So anyway, yeah. So this process of recovery can clearly take a while. How do you deal with your mindset over this time? What— are there any techniques that you've used around around your, your mindset?

Well, for me, I'm very goal-oriented and goal-oriented and solution-oriented, you know. And, uh, um, for what it's worth, I'm a retired published scientist and engineer, so I, I, I'm very solution-oriented. And you— and in my case, I kept the eye on the prize, which is, which is intimacy. My wife and I have been together for 40, going on 49 years. Yeah. And, and you just, you don't, I, I've got a tattoo. You can't see it here, but it's, it has the famous quote of Winston Churchill who was speaking during World War II and said the famous 3 words, never give up. And that's my mantra. And it's been my mantra for beating cancer. It's my mantra for beating ED. Never give up. So that's the message I'm giving your listeners for both partners.

And that leads me on to my next question, which is that you've obviously got an amazing partner who's been supporting you through all this. What can you advise other people who perhaps are struggling? I know that, you know, lots of women have problems when, when their partners have ED, even if it's caused by cancer, thinking It's, oh, maybe they don't fancy me enough. Maybe it's— this is my problem, you know. How can you— what would you say to men in how they can support their partners in helping them navigate this journey together?

Well, first of all, it really helps to, to be in a loving and patient and giving relationship. And, and, you know, and here's the reality of it, okay. Your sex life, even without an erection, isn't over. You know, you can have non-penetrative sex and you can still have a good time. It's penetrative sex that's going to take a back seat for a while. So you have to be flexible. You have to pivot and you have to face it together and say, you know what, I care about you. Okay. I want to have a good life and we're on a journey and let's be on that journey together.

Yeah, and obviously the other side of this is, it's not just the physical side, but you've got— you mentioned that you've got a little bit of libido. That's difficult, right? I mean, I know for me, my libido isn't what it was. And one of the things I've said to people is that I'm quite intentional when it comes to my approach to sex. Like, I like it, so I want to keep doing it. Like, I don't have to have it, but I want to have it because I enjoy it. And so I make time for it. I prioritize it in my life. Do you, you know, are you one of these diarized people? I've gotten into discussions with people about this, about do you diarize your intimate life or do you just, can you still be spontaneous? I'm a diary person, frankly, 'cause—

Well, you know, I think, I think in the situation that I'm in, and a lot of men are in, and couples are in because of, you know, ED caused by prostate surgery and cancer, you wind up having to make it a priority. You know, you have to say, you know what, this is going to be a priority. This is going to be part of our relationship. We're going to work through it. And when we're not, because let's face it, intercourse doesn't take a lot of time. So when we're not doing that, what are we going to do? We're going to snuggle, we're going to kiss, we're going to be together, we're going to be present with each other, we're going to hold hands. Okay, we're going to take walks, we're going to go places. So it's the whole enchilada.

Yeah, completely. And I'm curious to know, because I suspect that one of the things that when, when something like this happens, it sort of forces you to have difficult conversations. Were you always as open with your partner about your intimate life as you be, or did that become more urgent because of what was, what was happening?

It's such a great question. You know, we've been together for a long time, and we hardly talked about those issues. And it forced us to have to have very frank discussions about you know, what, what the past was, what the future would hold, and how we're going to get there. And it was really difficult. And I give my wife great credit for being such a wonderful support in my life. I could not face this without her.

Yeah, because I, I can imagine how challenging that conversation would be. And I think as an older person, often we don't really have the vernacular to talk about our intimate lives because just wasn't something that a lot of us did, right? We didn't, we didn't really have sex education. We kind of just got on with it. We just thought, yeah, this is what we're doing. It feels good. That's good. And then, you know, suddenly shit happens, right? And you have to go, you got to figure it out.

One of the things, if I'm going to hijack this for just a second, anyone who's listening, there's a great book out there, which I've read, called Saving Your Sex Life: A Guide for Men with Prostate Cancer. And by Dr. John Mulhall, and he is the director of sexual medicine over at Sloan Kettering in New York. Unbelievable book. This was life-changing. This was kind of— I looked at this and said, okay, we've got a lot of options. Something's going to work. So anyone listening to your podcast, I recommend the book. I don't get a spiff if you buy it or not., but you can get something out of it.

And if you could change one thing about how prostate cancer recovery is handled, what would you do?

Um, that's a great question. I think we all need to be adults about this, and we need to be open about conversation. Locally, I've counseled some men 10, 20 years younger than me. And I have a handout that I've, that I've written up and it explains, you know, what the challenges are and the stuff that the doctors should tell you but don't.

Yeah.

So, so I'm trying to do my little thing to make the world a better place. And, and I wish the medical community had the bandwidth and time to do that.

Yeah. And it's funny that you're talking about doing a handout because yesterday I had a conversation with a woman who deals with men with prostate cancer from the pelvic floor side of things, because there's a big impact on the pelvic floor. We haven't really discussed that. And she, you know, she has dilators and other exercises and things that she encourages men to do. But she was saying again that we were both saying about the fact that sexual health is often the last thing they want to discuss. And maybe we just produce a handout for collaboratively of you're going through prostate cancer, this is how your sexual life is going to potentially change. You're going through breast cancer, did you know this about your sex life? You're going through anal cancer, guess what? Things are going to happen to you, right? Because, because nobody gives this information, it seems, or very few people. I can't say no one, but very few professionals, probably like you said, they just don't— maybe they just don't have the bandwidth. I know I spoke to urologist and he said to me, look, we just try and get people through the surgery. We're not really, we're not really focused on what happens. We just want them to get through the surgery and then we'll deal with the sexual stuff after that. And, and the sexual health nurse said, but maybe it would be a lot easier for them to deal with it if they knew about it to start with. And also what Amanda said, which I think is even more important, is the sooner you can get people onto pelvic floor training, right after, right after surgery, the more likely it is their erections are going to come back. So you need to go right in, you know, you need to get on top of it like immediately, not, not wait for the next visit from your doc. Oh, by the way, you could do a few of these things right now.

Well, you're, you're so correct. Two points here. One, men are told that erections may return anywhere from 9 months to 2 years later. And somehow or another, we walk away going, okay, is the erection fairy gonna sprinkle boner dust on us, right? Sometime during the night, and it's going to come back. It doesn't work like that. So, so, so you have to do things, you have to seek things. And And I started pelvic floor therapy. I went through 8 weeks of it. My pelvic floor therapist was a woman— Yeah. —and she had my whole medical history. And she said, "Do you have ED?" And I said, "Yes, it's severe." She goes, "I think I can help you with that." And she did. It wasn't embarrassing. And if I had some success, she would wink and she goes, "And how are things going," right? And I would go, Actually, they're going really well. Thanks for asking. So, so, you know, again, this comes back to us being adults, right? I mean, come on. It's the elephant in the room no one wants to talk about, but it's an important elephant. Yeah, absolutely.

For sure. And so, you know, I'm curious, you— we started corresponding on Substack. And now you've taken that and you started your own stack. What's your intention with that? Why have you done that? And what's— and have you had any feedback since? I know you've only just started, but yeah, it's gone.

It's gone. It's gone very well. It's gone. It's kind of got a life of its own, you know. So I'm tackling each aspect of a side effect of menopause. So my next post is going to be on Hot Flash Hell, and I'm stealing that from a title from Dr. Lauren Stryker. Suzanne Noble, who's also written— I've spoken to her. She's amazing. She's helped me on my journey and she's helped people that I know. So I think she's wonderful. I'm going to borrow that and I'm going to explain, you know, to men, right? Or put it out there to women so they can print it out and hand it to their partners and, and try and get through in the way we men communicate what their partners are going through. So, so that's something. So I'm gonna go through, I'm gonna talk about libido. I'm gonna talk about brain fog. I'm gonna talk about muscle ache and muscle wasting. I'm gonna take all that and then I'm gonna, once I'm done with this, I'm gonna pivot and I'm gonna talk about, I'll, I'll have a, a new thread and I'm gonna talk about getting the right help for prostate cancer, where to get, what resources to look at. And then the third one will be on recovering sexual function. After surgery. So I've got big plans. That's great.

And, and I think as well, you know, with Substack, one of the things that I've discovered is you kind of find your own community there, even though there's no sexual or sexuality category, which is a shame because there's, there's a lot of people writing amazing stuff about sexual health, sexuality, all of that. But we sort of find each other. And so, and everybody I find is incredibly supportive. It's such a nice bunch of people. And, and it's a really great way to get a message through to what feels to me, because I'm on multiple platforms, it feels to me like an audience that is much more aligned with, with the kind of people that you want to reach. You know, I always joke that my fans on TikTok are mainly young African men who want to marry me. And my Facebook people are people who just want to do like naughty things. And then my Substack people are people who comment intelligently and are really curious and generally want to understand more about this aspect of their life at this age, how they can improve their sexual life. And so I feel that even though they're a smaller audience compared to some of the other platforms that I'm on, that they are a much more important one in being more aligned. So I think you'll find that you're gonna you're going to hit the people that really want to know. Plus, it's going to start ranking on Google, which is always very helpful, which, you know, I didn't realize until I started doing it. Like, it actually starts— these things actually start ranking on Google. So you did mention that you wanted to, you know, you want to live your best life. And despite all of these challenges, how has this whole experience shaped your outlook on life and relationships?

Um, well, first and foremost, I feel, um, I feel lucky to be alive. I feel lucky, even luckier, to be married to my wife. I mean, you know, we've known each other since we're very young, and I have such a greater appreciation for the person she is and what she's done. And I wish everyone would have, however it works out, the same happiness that I've had. For those of you who can't see me, I'm a very good-looking man. Okay. And modest too. Okay. But if you could see me, you'd see someone who's in it to win it. So I'm in it to win it, to beat cancer. I'm in it to win it, to beat ED. I'm in it to win whatever it takes. And I think that attitude is what I want to leave people with. If you're going to be in it, be in it to win it.

Yeah. And despite all the stuff that's going on in America that I'm not talking about, I do think that there is definitely an American attitude. You know, there is a very— I'm American, obviously, as you can hear, but I live in the UK. So I've adopted a lot of the cynicism and negativity of a typical British person. But I'm still underneath it. Everyone says, oh, but you're always so positive. And I think generally we Americans are positive, right? We want to beat, you know, we want to, in this case, in the best possible way, we want to win this battle with our health and we want to live our best lives. And I think that you're proof of that, of a guy who clearly has risen, pardon the pun, to the challenge.

I love it. Well, hey, that's one reason I'm here, right? Hope to rise to the challenge again soon.

We all hope that you will, Bob. So, um, and where can people find out more about you?

Well, um, the best place truly is Substack. Um, you know, I have all the content I'm writing is free. You know, all of us just leave footprints in the sand, and, and I'm trying to do some good You know, while I'm here, I've had my 15 minutes of fame. Now I'm up to 16, I think. But, but it really— look for me on Substack. You have a question, you know, message me. I'll do my best to help anyone and everyone who's sincere and reaches out for help. That's great.

And I think the more, as you said, the more you can provide advice and support and also signpost people to sympathetic doctors, places where they can get great information, the better, because the world needs more of that. Absolutely. It's been such a pleasure to have you on Sex Advice for Seniors, and I wish you so much luck with your Substack called A Man, Comma, Paused. Is it, is it bobmysack.substack.com?

Yes, it is, as a matter of fact.

Oh, it is? Okay, because I didn't know whether it was the title or not, but Suzanne Noble, it's, it's been fabulous and hope to have you on again.

Well, this has been really fun and thanks for inviting me and to everyone out there, live your best life.