From the Guidelines
Testosterone replacement therapy should only be offered to testicular cancer survivors with testosterone levels below the normal range and clinical symptoms of hypogonadism. When considering testosterone therapy for patients with a history of cured testicular cancer, it is crucial to prioritize their morbidity, mortality, and quality of life. According to the most recent and highest quality study, patients should undergo regular hormonal assessments to evaluate their long-term risk of hypogonadism 1.
Key Considerations
- Testicular cancer survivors should be followed with regular hormonal assessments regarding their long-term risk of hypogonadism 1.
- A healthy lifestyle should be encouraged for better well-being and minimisation of cardiovascular disease and secondary cancers, which are the most serious long-term toxicities 1.
- The decision to start testosterone replacement therapy (TRT) should be made on a case-by-case basis, taking into account the individual's overall health, the type and stage of the original testicular cancer, and genetic factors.
Monitoring and Treatment
During treatment, regular monitoring is essential, including testosterone levels, complete blood count, prostate-specific antigen (PSA), and liver function tests every 3-6 months initially, then annually. The rationale for caution is that some testicular cancers may be hormone-sensitive, and there's a theoretical risk that testosterone could stimulate recurrence or growth of residual cancer cells. However, current evidence suggests that for most patients with completely cured testicular cancer, TRT presents minimal risk when properly monitored. Standard TRT options include injectable testosterone cypionate or enanthate, transdermal gels, or pellet implants.
Evidence-Based Decision Making
The American College of Physicians has evaluated the efficacy and harms of testosterone treatment in men without established conditions that cause permanent testicular or hypothalamic–pituitary dysfunction 1. While this study provides valuable insights into the use of testosterone therapy, the most recent and relevant guideline for testicular cancer survivors is the ESMO-EURACAN clinical practice guideline for diagnosis, treatment, and follow-up 1. This guideline emphasizes the importance of individualized assessment and monitoring for testicular cancer survivors considering testosterone replacement therapy.
From the Research
Testicular Cancer and Testosterone Therapy
- The safety of testosterone therapy in patients with cured testicular cancer is a topic of ongoing research, with some studies suggesting that it may be beneficial for certain patients, while others indicate that it may not be necessary for all patients 2, 3.
- A study published in 2022 found that testosterone replacement therapy did not improve anxiety, depression, sexual function, fatigue, or overall quality of life in patients with mild Leydig cell insufficiency compared to placebo 2.
- Another study published in 2024 found that testosterone replacement may be beneficial in patients with impaired quality-of-life metrics, metabolic factors, and bone mineral density at baseline, but that routine supplementation for all individuals in this patient population lacks efficacy 3.
- The management of testicular cancer survivors, including the use of testosterone therapy, is a complex issue that requires a multidisciplinary approach, taking into account the individual patient's needs and circumstances 4, 5, 6.
- The decision to use testosterone therapy in patients with cured testicular cancer should be made on a case-by-case basis, taking into account the patient's overall health, medical history, and individual needs, as well as the potential benefits and risks of therapy 2, 3.