Based on PubMed | Can chemotherapy, radiation, or orchiectomy for testicular cancer cause low libido, and how long might it last and what can be done to manage it?

Yes chemotherapy, radiation, and orchiectomy for testicular cancer can be associated with low libido for some people, though the cause, intensity, and duration can vary by treatment type and by the individual. Loss of sexual desire (libido) is a recognized effect during and after cancer therapy, influenced by hormones, physical side effects, fatigue, and emotional stress. ^{[1] [2]} In testicular cancer survivors, studies show changes in sexual desire and function can occur after orchiectomy and adjuvant therapies, with radiation linked to a higher rate of persistent sexual problems in some cohorts. ^{[3] [4]}

Why libido can decline

• Hormonal changes: Removing one testicle (orchiectomy) usually preserves testosterone production in the remaining testis, but some people develop low testosterone (hypogonadism) years after treatment, especially with more intensive therapy. ^[5] Low testosterone can reduce libido, energy, and mood. ^[6]
• Treatment side effects: Chemotherapy can cause fatigue and affect overall well‑being and interest in sex during treatment; desire often improves as you recover. ^[1] Radiation can directly affect sexual desire and function in some, particularly when abdominal/pelvic fields are involved. ^{[3] [7]}
• Emotional and relationship factors: Anxiety about fertility, body image concerns after losing a testicle, and stress around cancer can dampen desire. ^{[4] [3]}

How long it might last

• Short term (during and soon after treatment): Libido commonly dips during chemotherapy and in the months following due to fatigue, nausea, and stress; this can be temporary and improve with recovery. ^{[1] [2]}
• Longer term: In testicular cancer survivors, erectile and desire issues may persist for a subset, with some studies finding radiotherapy patients reporting lower libido and other sexual difficulties compared with age‑matched controls months to years later. ^[3] In broader survivor data, sexual arousal/desire can remain reduced after treatment for some, though many improve over time. ^[2]
• Recovery timelines: One long‑term study reported that recovery of normal erectile function (a related marker of sexual health) often occurs over several years, with median recovery around 60 months after chemotherapy or radiation; radiotherapy independently predicted slower or incomplete recovery of erections, but desire domains were not uniformly impaired for all. ^[8] This suggests libido can recover for many, though pace and extent vary.

What you can do to manage it

• Check hormones: Ask for morning total testosterone with LH and FSH; if repeatedly low with symptoms, testosterone replacement therapy (TRT) can be considered when fertility is not an immediate goal. ^{[6] [5]} TRT can improve sexual desire, energy, and mood in symptomatic hypogonadism. ^[6]
• Optimize TRT if anorchid or hypogonadal: In men who required bilateral orchiectomy, injectable testosterone undecanoate has been shown to be safe and effective, though dosing intervals often need individual adjustment. ^[9]
• Address erectile or ejaculatory symptoms: Medications and rehabilitation programs can help erectile and orgasmic difficulties that often travel with low desire. ^[10]
• Treat contributing factors: Manage fatigue, pain, sleep, depression, and anxiety, all of which can suppress libido. ^[2] Counseling individually or as a couple can relieve performance pressure, body‑image concerns, and communication barriers. ^{[10] [11]}
• Sexual health services: Comprehensive programs for male sexual and reproductive health can create a personalized plan combining medications, hormonal therapy, fertility counseling, and psychosexual support. ^{[10] [12]}
• Fertility support and planning: Concerns about fertility often weigh on desire; specialized fertility programs can evaluate sperm production, options for banking, and paths to parenthood after treatment. ^{[13] [14]}

Practical steps to discuss with your care team

• Ask for a targeted workup: morning total testosterone (repeat to confirm), LH, FSH, SHBG as needed; screen for depression, sleep issues, and medication side effects. ^[5]
• If testosterone is low and symptoms are present, discuss TRT risks/benefits, goals (mid‑normal range), and formulation choices (gels, injections, patches), with monitoring. ^[6]
• If erections are also affected, consider PDE‑5 inhibitors and structured sexual rehabilitation, alongside communication and counseling support. ^{[10] [11]}
• Plan long‑term follow‑up: Survivorship care should include periodic hormonal and metabolic assessment, as hypogonadism is linked to bone and cardiometabolic risks over time. ^[5]

Key takeaways

• Low libido can occur with chemotherapy, radiation, and after orchiectomy, through hormonal, physical, and psychological pathways. ^{[7] [1] [3]}
• For many, desire improves as treatment side effects fade, but a subset especially after radiation may have longer‑term issues. ^{[2] [3] [8]}
• Evaluation for hypogonadism and personalized sexual health care (including TRT when appropriate) can meaningfully improve libido and quality of life. ^{[6] [9] [10]}