What are the effects of hormone treatment post-orchiectomy?

From the Guidelines

Hormone treatment post-orchiectomy is recommended to alleviate symptoms and improve quality of life, with estrogen therapy being the most effective treatment for managing vasomotor symptoms in postmenopausal women, as stated in the 2017 NCCN clinical practice guidelines 1.

Key Considerations

• The use of hormone therapy should be individualized based on risks and benefits, with alternatives to hormone therapy tried first, and patients referred to an appropriate specialist for dosing and management 1.
• Estrogen transdermal formulations may be preferred over other formulations due to lower rates of venous thromboembolism (VTE) and stroke 1.
• Micronized progestin may be preferred over medroxyprogesterone acetate (MPA) due to lower rates of VTE and breast cancer risk 1.

Treatment Regimen

• Start with a low dose of estradiol, such as 0.5 mg oral tablet daily or a 0.025 mg transdermal patch twice weekly, and adjust the dose based on symptom relief and side effects.
• If the patient has an intact uterus, add cyclic or continuous progestogen to protect against endometrial hyperplasia, with cyclic use of medroxyprogesterone acetate 5-10 mg daily for 12-14 days per month, or continuous use of 2.5 mg daily.

Monitoring and Follow-up

• Regular follow-ups with a healthcare provider are essential to monitor treatment efficacy and adjust as needed, with consideration of the patient's overall health and quality of life.
• The 2013 USPSTF recommendation statement also highlights the importance of weighing the benefits and harms of hormone therapy, with convincing evidence that estrogen alone reduces the incidence of fractures, but is associated with moderate harms, including stroke, gallbladder disease, and urinary incontinence 1.

From the FDA Drug Label

Testicular atrophy, subfertility, and infertility have also been reported in men who abuse anabolic androgenic steroids [see Drug Abuse and Dependence (9. 2)]. During treatment with large doses of exogenous androgens, including testosterone gel 1. 62%, spermatogenesis may be suppressed through feedback inhibition of the hypothalamic-pituitary-testicular axis [see Warnings and Precautions (5.8)]. Reduced fertility is observed in some men taking testosterone replacement therapy.

The effects of hormone treatment post-orchiectomy are not directly addressed in the provided drug labels. However, the labels do discuss the effects of testosterone treatment on fertility and testicular function.

• Testicular atrophy and subfertility have been reported in men taking testosterone replacement therapy.
• Spermatogenesis may be suppressed through feedback inhibition of the hypothalamic-pituitary-testicular axis during treatment with large doses of exogenous androgens, including testosterone gel.
• Reduced fertility is observed in some men taking testosterone replacement therapy. 2

From the Research

Effects of Hormone Treatment Post-Orchiectomy

The provided studies do not directly address the effects of hormone treatment post-orchiectomy, as they primarily focus on hormone replacement therapy (HRT) in women who have undergone hysterectomy, bilateral oophorectomy, or other gynecological procedures. However, we can discuss the general effects of hormone treatment in similar contexts:

• Hormone Replacement Therapy (HRT): HRT is commonly used to alleviate symptoms of menopause, such as hot flashes, vaginal dryness, and osteoporosis, in women who have undergone surgical menopause due to bilateral oophorectomy or other procedures 3, 4, 5.
• Benefits and Risks: The benefits of HRT include relief from menopausal symptoms, improved quality of life, and potential reduction in the risk of osteoporosis and cardiovascular disease 4, 5. However, HRT may also increase the risk of breast cancer, endometrial cancer, and other health issues 4, 5.
• Guidelines and Recommendations: Various guidelines recommend individualized assessment and decision-making regarding HRT use in women who have undergone surgical menopause, taking into account their medical history, risk factors, and personal preferences 5, 6, 7.
• Compliance and Practice: Studies have shown that compliance with guidelines and recommendations for HRT use in women undergoing surgical menopause can be poor, highlighting the need for improved education and awareness among healthcare providers and patients 7.

Some key points to consider:

• HRT can be beneficial for women who have undergone surgical menopause, but it is essential to weigh the benefits and risks on an individual basis.
• Guidelines and recommendations emphasize the importance of individualized assessment and decision-making regarding HRT use.
• Compliance with guidelines and recommendations can be poor, and efforts are needed to improve education and awareness among healthcare providers and patients.

Note: The provided studies do not directly address the effects of hormone treatment post-orchiectomy, and the information above is based on the available data on HRT in women who have undergone surgical menopause.