It’s Tuesday afternoon on a beautiful September day and I’m sitting alone in St. Thomas Church on 5^thAvenue in New York City, crying that I can't have an orgasm. I’m still crying when I hear it. Random staccato notes on the pipe organ. I laugh, imagining a cat has broken into the organ room and is walking haphazardly across the keys. This isn’t how I expected my day to go, but here we are.

My “journey” begins early in the year when a high Prostate Specific Antigen (PSA) test during a routine physical (“it’s probably nothing”) leads to an MRI (“it may be nothing”), then  to a biopsy (“there’s still a chance it’s nothing”), and finally to a diagnosis, over Zoom, of unfavorable intermediate stage prostate cancer.

There must be a mistake. They must have mixed up my results with someone else’s. Does that happen? Probably not. My husband cries with me, but eventually falls asleep. Waves of terror continue to pass through me. It’s 2 AM. I can’t sleep and my thoughts are racing. My husband is fast asleep and the dog is snoring. Maybe rubbing one out will help. I ejaculate blood. I’d been warned this is a side effect of a prostate biopsy, but it’s still jarring.

The next morning, in a somewhat dissociative state, I make an appointment at a major cancer center in New York City. It’s not for three weeks. I take this as a sign that I’m going to live for at least three weeks.

I go online. From Dr. Google, I learn prostate cancer is a deadly, virulent disease that spreads and kills quickly but is so slow growing and indolent that it’s not worth testing for or treating. Dr. Google tells me stories of impotent men wearing diapers years after prostate surgery but that men recover quickly and are back on Grindr in weeks. Dr. Google says surgery to remove the prostate (prostatectomy) is the gold standard but that gay men should never have prostate surgery. Dr. Google informs me radiation is as effective as surgery with fewer side effects but that the side effects of radiation are much worse and that everyone, including gay men, should have surgery. I learn my sex life will be ruined, and my husband will leave me, but we will be closer than ever and continue to have great sex.

I find an online gay men's support group and attend my first meeting. I nervously log in and the guys are joking about artificial urinary sphincters, arguing if bottoming is the same without a prostate, and discussing the pros and cons of the dry ejaculation that results from treatment (Pro: no mess to clean up. Con: no mess to clean up). I tell my story. They’ve heard it 100 times but listen politely and with kindness. I’m still in anger and denial, careening towards depression, while most of them have passed bargaining and are well into acceptance.

With prostate cancer, the patient generally decides the treatment. Surgery or radiation are the standard of care. Focal therapy, high-frequency ultrasound and other treatments are the alternative methods. Ivermectin and high-dose marijuana oil are touted as miracle cures in some online circles but thankfully not mine.

After careful deliberation (asking Siri for a random number), I choose SBRT--five sessions of high-intensity external radiation.

I’m scheduled for surgery to have three gold fiducial markers, each the size of a grain of rice, sewed into my prostate. These are used during radiation treatment to ensure the beam stays where it’s supposed to and doesn’t fry other organs if I breathe, move slightly, or run screaming from the table.

Because my stage is unfavorable, I’m told I must also do six months of Androgen Deprivation Therapy (ADT), which is a polite way of saying “chemical castration,” which is a polite way of saying “cutting your balls off without cutting your balls off.” Prostate cancer feeds on testosterone, so shutting off T helps radiation work better. I ask the side effects and am told “hot flashes and tiredness.”

Things are normal the first couple of weeks. My husband and I have sex once a week like the long-time married couple we are. By the third week, I can’t reach orgasm. I decide to try a different move to see if it’s better, but my husband uses his safe word, which is “what the hell are you doing?!?” The ADT is in high gear and my testosterone is gone. I’m tired, I have no appetite, I’m moody, I can’t concentrate and my dick doesn’t work. That night I lose it.

I’m in bed bawling my eyes out and I start screaming “I want to die! Please, just let me die” over and over and over. My husband gently puts his body on top of mine, strokes my hair, and tells me “It’s OK. I’m here for you. We’re going to get through this.” I’m still screaming when our American English coonhound becomes alarmed and starts baying at me. We laugh uncontrollably. I’ve never felt more in love with my husband (or my dog).

The day of the surgery to implant the markers arrives and I’m crying again. I’m crossing the Rubicon. I dread anesthesia because it makes me vomit. I tell the anesthesiologist this and she assures me it won’t happen with her. I wake up sore, but not nauseous. I will always ask for a female anesthesiologist from now on.

I’m wheeled to the recovery room. My husband holds my hand as the nurse comes in and gives me a tiny juice box with some first-grade math problems on the back. At least I’m still sharp enough to add 5 + 4.

We head home. Every pothole hurts and, living in New Jersey, there are a lot of potholes.

I read about “penile rehab,” which is taking low dose Viagra or Cialis during treatment. This is thought to prevent atrophy and reduce shrinkage. None of this was mentioned by any of my doctors or nurses, but I get a Viagra prescription with 12 refills. The pharmacist gives me a sly smile when I fill it.

When it’s time to start radiation, I go for a “simulation” where they run me through the process without actually frying my prostate. The “process” involves an enema and drinking 16 ounces of water and holding it for an hour to keep my bladder full and out of the radiation field. I make a mental note of how unpleasant this is in case I’m ever a dom top and my sub wants some degradation play.

Every other day, for five days, I lie on the table while the technicians align me under the beam. They pretend not to see my ever-shrinking junk and I pretend they can’t see my ever-shrinking junk. They ask me what music I want to hear. I want them to think I’m cool so, over four days, I select Nicki Minaj, Lana Del Rey, Noah Kahan and Chappel Roan.

On my final day I bring cupcakes for the techs who were professional, kind and empathetic. I ask for Lady Gaga, hoping to get something upbeat like “Gypsy” or “Applause” but instead I get “Shallow.” Bradley Cooper’s raspy voice barely rises above the noise of the linear accelerator circling around me and turning my prostate into a smore. I hope the techs aren’t too busy eating cupcakes to forget to turn it off.

I ring the bell signaling the end of treatment but it’s not really the end. There’s still four more months of ADT. Radiation and ADT make me tired. I nap every afternoon until the dog decides I've had enough sleep and smacks me with her paw. The idea of food becomes increasingly unappealing, and I lose weight. I work out like a fiend. Weightlifting 3-4x a week, cardio every day and walking the dog four miles, rain or shine. It doesn’t matter. ADT causes muscle loss and I’m starting to get a “cancer belly” which I hide by wearing oversized (and overpriced) shirts I buy from fancy stores after my doctor appointments in New York.

Over the next month all my body hair falls out. My husband says I look like a swimmer, but I think I look like a raw Costco chicken. It’s been a month since radiation, and two months into ADT. I can’t sleep, my joints hurt, my memory is gone, my dick is dead, and I’m having bad thoughts again. I find a therapist. I start taking an antidepressant.

I make an appointment with a sexual health specialist in New York. Before the doctor comes in, his assistant measures my now-pre-pubescent penis and testicles, stretches my penis to see if it still has elasticity, shakes his head from side to side and types a bunch of notes into the computer. The doctor says my anorgasmia is due to ADT. I tell him I’m relieved because ADT is almost over. He tells me the effects will continue for six months or more after stopping, and that a significant number of men never get back any testosterone at all. He smiles, gives me a fist bump and leaves.

My soul is crushed. I head outside and walk down 5^th Avenue. Instead of fantasizing about the hundreds of hot men walking past I try to guess their testosterone level. Beard and lots of body hair—at least 800. Older with a mustache—probably 450. Metrosexual—320. Thin, young twink—at least 1,000. My inner voice tells me I’m a neutered dog. I feel tears coming, so I weave out of the sea of people and into the near-empty church. I cry and pray until the imaginary cat walks across the pipe organ and I’m OK again.

On the bus home, I ask myself why I’m so concerned with sex and my physical appearance when I should be thinking that my treatment is saving my life. I realize it’s because I know it’s going to work so I don’t have to think about it. There’s a 70% chance. That’s pretty good, isn’t it? I mean, it’s not like anyone dies from prostate cancer right—never mind. I can’t think about that. I’m tired but at least I know what I’ll be discussing with my therapist later in the week.

I head home and my husband has set out all the fixings for homemade burritos, one of my favorite meals. He hugs me. For now, the ADT is not messing with my emotions, so we eat our burritos and watch Gordon Ramsay berate some poor young home chef for her not-so-great macaroni and cheese. “This is the worst thing that could possibly happen to me!” she says. “Not by a mile,” I think.

I sit on the couch and rest my feet on my husband’s lap. The dog wants in on the action and climbs next to me. Here we are, three living creatures enjoying an ephemeral moment together. I soak it in instead of taking it for granted like I would have in the BC (before cancer) times. For the first time in awhile, I’m deeply and fully aware of the silent but real love radiating between the three of us and that someday it's going to end. I tell my husband, out loud, that I love him. He rubs my leg. “Are the burritos OK?” “Perfect,” I reply.

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John and his husband Carlos moved to New Jersey from San Francisco in 2021 and are enjoying the suburban life. John can be contacted at jsr26 at msn dot com.