Should patients with esophageal cancer stop taking testosterone (hormone replacement therapy)?

Testosterone Therapy in Patients with Esophageal Cancer

For patients with esophageal cancer, testosterone therapy should not be automatically discontinued, but rather decisions should be made through a patient-centered approach weighing quality of life benefits against theoretical cancer risks, as there is insufficient clinical evidence demonstrating harm. 1

Understanding the Evidence

The relationship between testosterone and esophageal cancer is complex and not well established in clinical literature:

• Limited research exists specifically addressing testosterone therapy in esophageal cancer patients
• Some preclinical studies suggest testosterone may influence esophageal cancer cells 2, but clinical translation is unclear
• The Multinational Association of Supportive Care in Cancer guidelines (2025) emphasize that decisions about hormone therapy in cancer patients should be patient-centered 1

Decision-Making Framework

Factors Supporting Continuation of Testosterone:

• Quality of life considerations are paramount - testosterone therapy may be "life-saving" for some patients by improving gender dysphoria, depression, anxiety, and suicidality 1
• No prospective clinical data exists to definitively estimate the risk of hormone therapy on progression of hormone-sensitive cancers 1
• 35% of transgender individuals surveyed would continue hormone therapy even if diagnosed with a hormonally-dependent cancer 1

Factors Supporting Discontinuation:

• Some preclinical evidence suggests testosterone in high concentrations might promote certain hormone-sensitive cancers 1
• Early research from 1989 showed testosterone administration enhanced growth of an esophageal cancer cell line in laboratory studies 2

Recommended Approach

1. Assess the individual patient's situation:

   • Evaluate the necessity of testosterone therapy for the patient's wellbeing
   • Consider the stage and histological type of esophageal cancer (squamous cell vs. adenocarcinoma)
   • Discuss the patient's priorities regarding quality of life vs. theoretical cancer risk

2. Have a detailed risk-benefit discussion:

   • Explain that definitive clinical evidence on testosterone's effect on esophageal cancer progression is lacking
   • Discuss that some laboratory evidence suggests potential concerns, but clinical relevance is uncertain
   • Emphasize that quality of life benefits may outweigh theoretical risks for many patients

3. If continuing testosterone therapy:

   • Monitor cancer progression more closely
   • Consider dose adjustments if clinically appropriate
   • Maintain regular follow-up with both oncology and the provider managing testosterone therapy

Important Considerations

• Paternalism should be avoided; patient autonomy and informed choice are critical 1
• The decision to continue or discontinue testosterone should be revisited at regular intervals as the cancer treatment progresses
• For patients with hormone-sensitive cancers, the benefits of gender-affirming hormone therapy on mental health and quality of life may outweigh theoretical risks 1

Special Circumstances

For patients with advanced esophageal cancer:

• Quality of life becomes even more central to decision-making
• The theoretical risk of testosterone accelerating cancer progression may be outweighed by significant improvements in wellbeing and mental health

For patients in remission:

• Continuing or restarting testosterone therapy may be more appropriate after successful cancer treatment
• Regular monitoring for recurrence should be maintained

Remember that while some preclinical evidence suggests testosterone might influence esophageal cancer growth, there is insufficient clinical evidence to mandate discontinuation for all patients, particularly when weighing quality of life benefits.