Mood, sexuality, and relational intimacy after starting androgen deprivation therapy: implications for couples

Patients on androgen deprivation therapy (ADT), a common treatment for prostate cancer, report significant declines in quality of life and detrimental impact on their intimate relationships. ADT depresses a man's testosterone to castrate levels, leading to declines in sexual function, and changes in mood. These changes can have profound impact on couples' intimate relationships.

Patients undergoing ADT, and their consenting partners, were followed on a variety of outcomes relating to mood, sexual changes, and relational intimacy. Participants were assessed at baseline, 3 months, and 6 months. Changes in these three domains are documented. A dyadic analysis was conducted on the primary outcome of relational intimacy in order to assess the role of changes in mood and various aspects of sexuality on couples' intimate relationships.

Declines were observed in the first 6 months on ADT for sexual function, sexual frequency, and relational intimacy. Sexual bother increased within the first 3 months on ADT. No changes in mood were observed. Dyadic analysis revealed important effects on couples' reports of relational intimacy. (A) Patient and partner ratings of emotional intimacy were higher when partners better understood the patients' mood state. (B) Patient and partner ratings of sexual intimacy were higher when couples were more sexually active.

The current study confirms that patients experience reduced sexuality and relational intimacy during the first 6 months on ADT. Specific facets of relational intimacy are improved with increased sexual activity and also when partners recognize the emotional changes that patients are experiencing.