Testosterone Levels In Testicular Cancer Patients After Chemotherapy

Testosterone is a potent androgenic hormone that is produced by male gonads (or testicles) and is responsible for the primary development and maturation of reproductive organs when the baby is still inside the maternal womb. At the time of puberty, testosterone contributes to the development of male secondary sexual characteristics; e.g. growth spurt, muscle remodeling and strength, deepening of voice, growth of facial hair and an increase in the size of male sexual and copulating organs. The serum testosterone levels declines with advancing age, medical illnesses, poor nutrition and other serious diseases such as malignancy of prostate or testicles.

What Happens To Serum Testosterone Levels After Testicular Cancer?

Any disease or disorder of testicles or male genital system can greatly affect the secretion of testosterone. According to a study reported in the West Indian Medical Journal (1), investigates suggested that almost 40-60% patients with testicular cancer have some degree of hypogonadism (or low serum testosterone levels). The classic causes of hypogonadism in the setting of testicular cancer are:

• Damage to the testicular cells that are responsible for the production of testosterone due to cancer
• Destruction of testicular tissue due to hazardous effects of chemotherapy
• Orchiectomy (or surgical removal of testicles)
• The hormonal imbalance and endocrinological abnormalities due to persistent stress and metabolic changes of cancer
• Seminomas are most frequently associated with hypogonadism

Does Chemotherapy Reduces Serum Testosterone Levels?

Several clinical studies suggested that most patients have normal testosterone levels (even in the setting of testicular cancer); however, serum concentration of testosterone tends to declines significantly, after initiating the chemotherapy.

Chemotherapy was introduced as a viable treatment method of testicular cancer management in the early 20^th century. In fact, it is the most promising treatment for the management of metastatic testicular cancer (when cancer cells spreads to distant parts of the body). It is noteworthy that testicular chemotherapy for cancer has excellent prognosis, with more than 95% patients surviving after 10 years of successful chemotherapy. Nonetheless chemotherapy aggravates the risk of a

variety of other complications as well (besides hypogonadism); such as:

• Secondary cancers
• Toxic damage or destruction of lungs
• Permanent infertility
• Cardiovascular diseases
• Damage to the nervous system
• Destruction or damage to the renal system
• Psychosocial problems
• Hypogonadism

What Are Some Sign And Symptoms Of Low Testosterone Levels?

Serum testosterone levels fluctuate through the life of a man. In most cases, minor alterations in the serum level are silent or unnoticeable; but if the testosterone levels decline abruptly or significantly, the affected male may present with a wide variety of symptoms; such as, loss of libido, erectile dysfunction, impotency, and compromised quality of sex life. It noteworthy that this not only frustrates the affected men but can also ruin their sex life.

Here are some other ramifications of low testosterone levels:

• Poor quality and quantity of sperms
• Hot flashes, depression, irritability and mood swings (also referred to as characteristic sign and symptoms of male menopause or andropause)
• Negative changes in the testicular mass
• Weakening of bones (negative changes in bone mineral density that may also increase the risk of pathological fractures)

• Loss of muscle mass

Are There Any Long Term Implications Of Hypogonadism Due To Chemotherapy?

Long term testosterone deficiency or hypogonadism is reported in 12 – 18% survivors of testicular cancer (3). Unfortunately, poorly managed or chronic hypogonadism can lead to a variety of complications in cancer survivors such as; metabolic syndrome, poor quality of life, osteoporosis, type 2 diabetes, premature aging, and heart dysfunction (3).

In addition, for normal restoration of spermatogenesis, adequate gonadal functions is very important. According to a new study, the fertility is reduced by 30% in testicular cancer survivors (4). If testosterone levels are not restored, the fertility can further decline in these survivors.

What Can Be Done To Manage Low Testosterone Levels Due To Testicular Cancer?

In most cases, no treatment or management is necessary as testosterone levels return to normal within 6 months of cessation of chemotherapy. But this is not the case in some genetically susceptible subjects. Therefore, early detection and adequate management is very important. Healthcare providers recommends maintaining a healthy lifestyle and dietary regimen in addition to supplemental formulations to restore the adequate health after cancer. Speak to your doctor to learn more about different testosterone replacement options and if you are a candidate for such therapies.

References

1. Sarfraz, M., Ashraf, Y., Sajid, S., & Ashraf, M. A. (2016). Testosterone Level in Testicular Cancer Patients after Chemotherapy. The West Indian medical journal.

2. Travis, L. B., Beard, C., Allan, J. M., Dahl, A. A., Feldman, D. R., Oldenburg, J., ... & Constine, L. S. (2010). Testicular cancer survivorship: research strategies and recommendations. Journal of the National Cancer Institute, 102(15), 1114-1130.

3. Yeap, B. B. (2009). Testosterone and ill-health in aging men. Nature clinical practice Endocrinology & metabolism, 5(2), 113-121.

4. Huddart, R. A., Norman, A., Moynihan, C., Horwich, A., Parker, C., Nicholls, E., & Dearnaley, D. P. (2005). Fertility, gonadal and sexual function in survivors of testicular cancer. British Journal of Cancer, 93(2), 200-207.