Hypogonadism following testicular cancer treatment leaves the man often with distressing symptoms. This means that the testosterone production is too low. The risk of developing hypogonadism following successful testicular cancer treatment was 3.8-fold in comparison to men without testicular cancer.
Even though these men do not feel well, many physicians who adhere to what they learned in medical school in the past. They are reluctant to prescribe testosterone replacement to men with hypogonadism.
Myth surrounding testosterone replacement
Conventional medicine teaches (and I have believed this for many years) that testosterone would be one of the causes of prostate cancer. This was based on old observations by Dr. Huggins, a Canadian born surgeon who practiced in Chicago, that orchiectomy improved the survival of advanced prostate cancer patients a bit. This concept has ever since been accepted, but reality is different.
Dr. Lee pointed out that Dr. Huggins neglected to realize that testicles make both testosterone and small amounts of estrogen. The belief that testosterone production was the culprit of prostate cancer led to the practice of physicians to do orchiectomies. This inadvertently removed the real cause of prostate cancer, which was an estrogen surplus. This improved the survival of these patients somewhat, but it was not a success story. Nowadays we have more sophisticated testing methods.
Estrogen causes prostate cancer, testosterone does not
Dr. Abraham Morgentaler (Ref. 1) has compiled a lot of evidence about the importance of testosterone in men. He proved, based on a lot of more modern references, that it is not testosterone that is the cause of prostate cancer. We know now that estrogen dominance is responsible for prostate cancer and that this develops, as stated above, because of the low testosterone and low progesterone during the male menopause (also called “andropause”).
It is important, when testosterone deficiency is present in an aging man, to replace the missing testosterone with bioidentical testosterone.
Some physicians still practice the old method of hormone depletion therapy in advanced prostate cancer cases. But Dr. Morgentaler and other researchers have shown that it is wrong to do hormone depletion therapy or orchiectomies.
2016 study showing that testosterone replacement does NOT cause cancer
But a 2016 study came to the conclusion that testosterone replacement did not cause prostate cancer, and prostate cancer patients with testosterone replacement did not have prostate cancer recurrences.
In the Platinum study with 491 testicular cancer patients there were 38% of patients who had low testosterone levels indicating they had hypogonadism.
Normally physicians are trained to treat hypogonadism with testosterone replacement. But when it happens in a cancer patient (like prostate cancer or testicular cancer) physicians become very reluctant to agree to testosterone replacement. They are governed by a fear that the cancer would be activated by testosterone.
It is encouraging that there are more and more other physicians who realize that testosterone does not cause testicular cancer: “If testosterone replacement therapy does improve a man’s symptoms following treatment for testicular cancer then it can be continued indefinitely.”
Heart attacks, metabolic syndrome, increased blood lips and cholesterol
A lack of testosterone leads to inflammation, to higher blood lipids, to elevated cholesterol levels and an increased risk of heart attacks. Physicians should do blood tests including a testosterone level to establish the reason for the increased heart attack risk. When the diagnosis is hypogonadism, treatment should consist of testosterone replacement. The blood level should be repeated every 3 months, and the testosterone level should be kept in the normal range. This will reduce the elevated cholesterol and triglyceride levels and will normalize the hypogonadism symptoms. The patient will feel normal, and in many cases his sex life will return to normal.
It has long been accepted that missing hormones need to be replaced: diabetics rely on insulin, if the production is no longer sufficient. Patients with thyroid deficiency receive replacement therapy. Nature-identical hormones for women in menopause are making inroads in progressive treatment. It seems that male testosterone deficiency has been sorely neglected, and it is time for physicians to address this!
We know now that testosterone replacement does not cause prostate cancer or testicular cancer. Any man who has had treatment for testicular cancer and is diagnosed with hypogonadism deserves testosterone replacement therapy. This will benefit him tremendously not only in terms of sex drive and muscle bulk development. It will prevent heart attacks, strokes and osteoporosis as well. He will have to have testosterone blood tests every three months to ensure that his testosterone level remains in the normal range. But this is a small price to pay for longterm health.
Ref.1: Abraham Morgentaler, MD “Testosterone for Life – Recharge your vitality, sex drive, muscle mass and overall health”, McGraw-Hill, 2008
Ref.2: What’s new about testosterone.