When Cancer Comes Calling – Book Three: Soundings
ADT – Making Deals with the Devil
David R. Weiss – September 23, 2025

Since mid-June I have been at a crossroads, desperate to avoid ADT (Androgen Deprivation Therapy). As of today, I am all in. To the point of annihilation. (All too literally.) It feels like a deal with the devil; multiple devils, in fact. And those devils are in the details, too.

ADT suppresses testosterone (the main androgen—“male-making”—hormone) as one facet of treating prostate cancer (PCa). ADT can stop (or at least dramatically slow) the growth of PCa in your body. It can shrink and weaken cancer cells and occasionally even kill them. Mostly, ADT aims to hold prostate cancer in check. (Until it doesn’t. Eventually PCa mutates and starts growing even with testosterone suppressed, but that’s a sad tale for another day.)

In my case, ADT is being used in combination with radiation therapy. Radiation is more likely to kill PCa cells if ADT has already weakened them. I’ll be on ADT for a month before my 33 sessions of radiation, which will run October 6 to November 19 (with weekends off for R&R). I started my first ADT med on September 5, and because ADT can help kill off cells damaged by radiation for several months after radiation ends, I’ll be on ADT for at least six months. However, because my particular cancer is “very high risk”—apex predator within the PCa family—the strong recommendation is that I remain on ADT for another 6-18 months: up to 24 months total. This would hopefully prevent my cancer from spreading beyond my pelvic region. But it’s a deal with the devil, and it comes with costs.

Radiation treatment has its own perils, but ADT feels much more ominous. As a systemic treatment that impacts my whole body—cancerous and otherwise—ADT is more akin to kicking a hornets’ nest. They’ll fly everywhere. Yes, the cancer will slow to a crawl, but the absence of testosterone will echo in my body (and mind!) in a host of other ways that have nothing to do with cancer. But everything to do with me. These are the devils that stalk me.

I’m on two ADT meds. And speaking of that “hornets’ nest,” these meds are so indiscriminate in their hormonal havoc that anyone other than me has to wear gloves to handle them. (I get to go bare-handed because they’re going to be making havoc inside me anyway.)

I started Orgovyx (relugolix) on September 5. It prevents the pituitary gland in my head from sending the hormone that prompts my testicles to produce testosterone. It effectively shuts them down. Rapidly. Within the first month my T-level will be as low as if I’d been castrated. Ouch! (It’s already almost there.)

I started the second ADT med, Zytiga (abiraterone), on September 19. Unlike Orgovyx, which targets the messaging center (the pituitary gland), Zytiga takes out the production facilities themselves: the testicles and the adrenal glands (which Orgovyx has no effect on). 95% of testosterone is made in the testicles; the remaining 5% comes from the adrenal glands. Zytiga makes it impossible for either gland to make any testosterone. It will drop my T-level as close to zero as is medically possible. This type of “combination therapy” is sometimes called Testosterone Annihilation because it is so unforgiving in its testosterone suppression.

My cancer has no idea what’s coming.

But I do. Call it collateral damage, if you wish. Some PCa doctors are honest enough to admit that, as helpful as ADT is in containing the cancer, its side effects are often nothing short of “catastrophic” for their patients. I’m still anticipating them, but they feel like deals with the devil. Multiple devils. Too many to count, but I can group them in five categories.

The devil I already know. Prone to melancholy since my youth, I’ve been through several bouts of severe depression. My melancholy likely has roots in the nexus of introversion, empathy, intelligence, introspection, creativity, etc. A “perfect storm” of traits (with antecedents in my family) that me me: passionate and driven. But also make melancholy my default mood, often just below the surface. Life stresses (and a couple life traumas) turned that melancholy into debilitating depression several times—one of which left me barely functional for months.

Now ADT says, “Hold my beer.” Because besides being the infrastructure of my maleness, testosterone also is crucial in men for healthy mood. It plays a central role in how our brains release two neurochemicals essential for mental health. Dopamine provides motivation and concentration, then tops these off with the feeling of reward. Serotonin, the “happiness chemical,” undergirds the sensation of calm, well-being, and emotional balance—as well as facilitating good sleep and appetite.

Imagine melancholy-me at Zero-T and it’s ugly. Add in the other side effects mentioned below as additional mental/emotional stressors, and it’s even worse. One guy, on Orgovyx for 6 months described his depression “MUCH worse than anything I’d experienced before; hard to describe—a sadness beyond sad.” Yes, there are things I can do, but I’ll be doing them in a raging current of madness. That’s the devil I know.

The devil I don’t yet know, but surely will. Not every person experiences every possible side effect of ADT. And (thankfully) the worst side effects are rare (but not impossible) if you’re on ADT for less than two years. But a handful of side effects are almost unfailingly present: complete loss of libido, hot flashes, fatigue, muscle loss, and accumulation of body fat around the belly. These results are simply what happens in a man’s body when the T is turned off. Our bodies are finely tuned instruments; they count on the right mix of hormones to hold to a healthy center. The average man loses 3-5% of their muscle during the first year of ADT (most of that within the first few months)—and replaces it with an average of 10 extra pounds of fat in their belly and on their hips.

Some guys report only mildly noticeable fatigue; others—including some on short term ADT—describe it as debilitating, even devastating. Hot flashes (which I haven’t experienced yet) are, of course, well known to menopausal women. But for men they come with a double whammy. Besides the immediate physical discomfort (and social awkwardness and/or sleep disturbance), for men hot flashes are also symbolically disorienting in the psyche. They provoke a sort of gender-sex vertigo: a reminder that this medication is playing with the foundational chemistry of my identity as a man.

And loss of libido. Check. It’s a surreal heart-breaking loss. Near the end of her life my mom barely remembered my older brother, Don (who died in 2004). I drove by the cemetery with her one day and she said, with wistful ache but little genuine emotion, “I think I have a son buried in there.” THAT type of loss. I can say, “I once longed for Margaret with erotic hunger that consumed me. At some level, I still ‘know’ that … but I can’t even imagine it anymore.”

Not that there isn’t deep love and intimacy and emotional tenderness between us still. There is—and vibrantly so! But eros? For now, at least, that is so much buried in my mythic past that I couldn’t tell you if it was ever real. And navigating that reality in our relationship is complicated and bittersweet, though more bitter than sweet, because while my libido has amnesia, Margaret’s libido is alive and well. It is a strange season for our love.

All these things comprise the devil I don’t yet know, but surely will. Here, too, there are things I can do. But these side effects have the hormones (or the absence of them) on their side. And that’s no small advantage.

The devil I don’t want to meet. ADT dysembodies you. It doesn’t dis-embody you (take you out of your body); no, it distorts the manhood you once had and taunts you with a femininity you never longed for.

With T-suppression in place, most men lose almost an inch of length in their penis. Some lose more. Some report they can no longer see their penis; that they can no longer pee at a urinal because there’s nothing to hold onto, and the pee just goes wherever it chooses. Funny? Not if every time you look at yourself in the mirror, you see a “pre-adolescent penis” on your aging man’s body. I already lost some of my penis length to Peyronie’s disease a decade ago. And I lost a bit more during my prostate surgery. When this devil comes my way, I’d like to say, “Sorry, I already gave,” but I doubt he’ll take that for an answer.

Alongside that, ADT shrinks your testicles from, say, the size of a grape tomato down to the size of a lima bean. This isn’t negotiable. There are no “counter measures” you can take. This IS what suppressing T does, and annihilating T will do as much as that and then some. Guys describe scrotums that are nearly “empty bags of wrinkled flesh” swinging between their legs holding next to nothing in them. They don’t find it cute. Dysembodiment is finding yourself exiled within your own body. Vertigo doesn’t do it justice, because beyond the physical sense of disconnection, it’s an emotional repulsion at foreignness-made-too-close-for comfort.

These bodily distortions are likely in my future. The literature tells me they “usually” reverse themselves when you stop ADT. But that same literatures always add a cautionary “but not always.” The devil is in these details, too.

And, because at Zero-T, the low levels of estrogen that naturally circulate in a man’s body have no testosterone to restrain them, they do what estrogen likes to do: build breast tissue. Men can experience nipple tenderness and breast development. This is more common beyond two years, but hardly unheard of in the first two years. Further, unlike the changes to male genitalia, breast tissue does not recede when ADT stops. I can cross my fingers it doesn’t appear. But, short of surgery, there is no way to remove it if it does.

There are a couple risky counter measures to forestall it. Tamoxifen, an estrogen blocker, has its own side effects. And “preventative” radiation of the chest is not always effective, rarely covered by insurance, and raises the risk of other cancers down the road. Finger-crossing, as futile as that seems, is probably my best bet.

This devil is close kin to the one that trans persons face as they come into their truth. They, too, experience the anguish-agony-anger over a body they know is not theirs, and yet is the flesh they wear. Each of us, cis or trans, is a self-interwoven-with-body. The sinews cling even when the fit is off. Which is why, for trans persons, medications like these can be life-saving, bequeathing a wholeness long apprehended at a visceral, intuitive level. And is also why, ADT can be so self-threatening to a man: it actively claws at those sinews until they rip away.

Recently, in response to Trump’s (and the entire Right’s) escalating war on the trans community, one of my longtime trans friends posted on Facebook: “It is time for Allies to stand up and declare, ‘I am transgender.’” Well, I have long been an Ally to the LGBTQ+ community, even aspiring to be an Accomplice in their liberation. Still today, as I find myself smack in the midst of ADT, I will proudly continue to be in solidarity with the trans community in every way I can. Still, when I saw her post—the very day before I started Orgovyx—I must admit the irony bit hard. This is the devil I don’t want to meet. But soon enough, in ways both visceral and emotional, I will be trans-gender.

[To be very clear: by calling myself “trans-gender,” I don’t mean to equate my reality on ADT with that of transgender persons. I am simply observing with poignant irony that these meds will put my gender in flux. They will unmoor me from the static security of the (illusory) gender binary and set me adrift somewhere … in between. That doesn’t make me transgender, but it might make me even more aware of what it is to exist in an in-between-space that much of the world chooses to deny—often vehemently—but which trans persons navigate daily.]

The devil that wants to wreck me. It turns out that quite beyond our mental health and our sexual health, testosterone is crucial to the structural integrity and the metabolic systems of our bodies. And ADT is about wrecking that, too. It begins with raised blood sugar, lipids, and blood pressure; over time it becomes diabetes and heart disease. It begins with muscle and joint aches; over time it becomes osteoporosis and bone fractures. Add in liver toxicity and irregular heartbeat. Bottom line, these meds will put irrepressible stress on multiple body systems, almost from day. It’s not guaranteed that any of these systems will give out, and if I can get off ADT in 18 months or so, I may escape the worst of these threats, but this is the devil that wants to wreck me. And it will be with me every step of the way.

The devil that would utterly undo me. Finally, there is the devil that is sheer terror for me. In some unpredictable slice of men, usually on long-term ADT, but occasionally even on short-term ADT, mental deterioration is pronounced. Brain fog and a diminished executive function can occur; the capacity to direct your own life can fade. Memory loss can be a minor daily annoyance—or show up as the wholesale loss of self in time and place. And for some, verbal acuity disappears. This whole essay is an exercise in verbal acuity. My life is woven out of verbal acuity. To be blunt: I would choose to die from cancer before choosing to surrender my verbal acuity. Hopefully it doesn’t come to that.

These mental side effects seem to be wholly reversible once ADT stops. But this is the devil that would utterly undo me. If these side effects show up, I will find the quickest “off ramp” from ADT that I can find.

Devils to my left. Devils to my right. I have no death wish, but don’t try to sell me on the merits of these drugs. Cancer set me down at this crossroads, and here I am, making deals with the devil. These medications are hellbent on making mayhem in the male body. One precious sliver of that mayhem may work to my advantage. For which I will be grateful. But there’s no cherry-picking with ADT. The many other slivers of that mayhem will be working persistently to undo me.

The prospect of gaining several years (dare I hope a decade or more?) of life … with cancer pushed well into the background is alluring: there’s the deal! But it’s hardly free. ADT is a whole series of deals with the devil. Every. Damn. Day.

There are ways to protect myself from at least some of the side effects (that’s for a future post)—and I intend to put these protective measures to full use. But pretending the dangers just ahead are anything less than everywhere and existential is no protection at all.

So color me wide awake, on edge, all in, and determined to hold my own as I make deals with the devil at the crossroads.

I’ve been chronicling my prostate cancer journey since my diagnosis in January 2025.
Find my first set of blogs (January-June 2025) in a pdf here: When Cancer Comes Calling: Innocence.
Find my second set of blogs (July-August 2025) in a pdf here: When Cancer Comes Calling: Awakening.
My third set (September 2025 and beyond) is under the theme “Soundings.” So far it includes:
#1 Self-Advocacy: Sorry—Not Sorry.
#2 ADT – Making Deals with the Devil

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David Weiss is a theologian, writer, poet and hymnist, “writing into the whirlwind” of contemporary challenges, joys, and sorrows around climate crisis, sexuality, justice, peace, and family. Reach him at drw59mn@gmail.com. Read more at www.davidrweiss.com where he blogs under the theme, “Full Frontal Faith: Erring on the Edge of Honest.” Support him in Writing into the Whirlwind atwww.patreon.com/fullfrontalfaith.