Hypogonadism and Fertility Issues Following Treatment For Testicular Cancer
Written by Ben Bunting: BA(Hons), PGCert.
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In addition to addressing the emotional and physical aspect of hypogonadism, treatment for the condition is also available. This article outlines the various types of hypogonadism, its symptoms and treatment options. A physician can advise you on the right course of treatment, as well as the best ways to avoid or treat hypogonadism.
Hypogonadism
Despite the fact that most patients who are diagnosed with testicular cancer will survive the treatment, hypogonadism and fertility issues can be serious issues for survivors. These problems can lead to reduced libido, decreased sex life, low energy, and depression. Moreover, hypogonadism can increase the risk of osteoporosis. In addition, hypogonadism can lead to other health complications, including cardiovascular disease and metabolic syndrome.
There are a number of possible causes of male hypogonadism, including hypogonadism due to cancer. It may also be caused by a problem with the hypothalamus or pituitary gland. These two glands are responsible for the production of hormones and signal the testes to produce testosterone.
In the United States, there are 240,372 men with testicular cancer. Approximately 8720 new cases were diagnosed in 2016. It is the most common form of cancer in young men. The median age at diagnosis is 33 years. Luckily, the disease is curable, and most men survive it until the later stages. However, treatment for testicular cancer can cause hypogonadism, which can affect fertility.
While some men may experience temporary azoospermia after treatment, others may experience permanent azoospermia. Alkylating agents, which disrupt DNA synthesis and RNA transcription in neoplastic cells, are most likely to cause permanent azoospermia. In addition, men with cancer may have abnormal sperm counts before the cancer diagnosis.
Despite the risks, advances in treatment for testicular cancer have led to better treatment outcomes for men with the disease. As a result, many men are able to father a child following treatment.
Types of hypogonadism
Hypogonadism, also called primary hypogonadism, is a condition in which men's sex hormones are low, or do not produce enough of them. This can be the result of a number of causes, such as endocrine problems or failure of the hypothalamus or pituitary gland to secrete luteinizing hormone. While it can lead to infertility, it does not increase the risk of mortality.
Hypogonadism can be treated by supplementing testosterone to the patient or by increasing his serum levels of luteinizing hormone. While infertility is not life-threatening, it can pose a major challenge to testicular cancer survivors. Although the disease is relatively rare, it can affect young adult men who are not yet ready to start a family.
Survivors of cancer should be asked about symptoms of hypogonadism and infertility following treatment. Laboratory tests can help diagnose hypogonadism and refer patients to specialists for further evaluation. A determination of FSH and LH levels can help differentiate between primary and secondary hypogonadism.
Another type of hypogonadism which affects fertility following treatment for testicular cancer which affects approximately 25 percent of men. This is known as Klinefelter syndrome. Klinefelter syndrome is caused by an extra X chromosome and the improper division of cells in the embryo.
Testicular cancer patients can experience impaired fertility due to gonadotoxic effects of chemotherapy. However, their sperm count can rebound after treatment. Some survivors even achieve paternity. This is an extremely good news for survivors, and it is an additional benefit that the survival rate of these men after treatment is excellent. Risk-adapted treatment protocols aim to reduce gonadotoxicity and improve efficacy. They also strive to enhance communication with patients and their families, allowing them to make an informed decision about their treatment.
Symptoms of hypogonadism
While most patients survive testicular cancer, it can still have devastating effects on the reproductive system. The condition can lead to reduced sexual functioning, infertility, loss of energy, and even depression. It has also been linked to metabolic syndrome and osteoporosis. It is important to discuss all of these side effects with your doctor, but the good news is that you don't have to live with the problems.
The normal timing of puberty is critical for children. In children, the absence of normal sex hormones can cause delayed pubertal development, a delayed growth rate, and reduced energy. Hypogonadism can also lead to decreased libido and depression. It can also increase the risk of osteoporosis and cardiovascular disease. It is therefore important to monitor patients carefully for any signs of hypogonadism and fertility after treatment for testicular cancer.
There are several causes of hypogonadism, including the cancer itself. A condition known as primary hypogonadism indicates a problem with the pituitary gland or the hypothalamus. These glands secrete hormones such as gonadotropin and luteinizing hormone. These hormones tell the testes to produce testosterone.
In recent years, advances in treatment for testicular cancer have improved the lives of men with this condition. Although the American Society for Reproductive Medicine and the American Society of Clinical Oncology have recommended fertility counseling after treatment for testicular cancer, not all patients have been able to follow their doctor's advice. It is important to understand what your treatment options are, and discuss the risks and benefits of each one.
Treatment for testicular cancer involves regular follow-ups with your urologist. Depending on the cancer's location and type, your doctor may recommend chemotherapy or radiation.
Treatment options
After treatment for testicular cancer, children are often required to undergo follow-up care, which includes regular physical examinations and medical tests. This helps doctors track the patient's progress and assess long-term health risks. Children with aggressive cancer are often followed for at least two years, after treatment. Common follow-up tests include physical exams, chest x-rays, and tumor marker tests. After the disease is removed, boys may require a prosthesis.
Some patients with testicular cancer experience adverse reproductive outcomes. Symptoms of hypogonadism and other fertility problems can interfere with a person's quality of life. This may lead clinicians to question whether these problems are the result of previous treatment. Fortunately, the majority of patients experience a full recovery from treatment.
Secondary testicular failure may occur as a result of radiation therapy. In addition to causing damage to the testicles, radiation may damage the pituitary gland, which secretes hormones necessary for sexual function. This may result in low levels of the hormones LH and FSH - the two hormones responsible for promoting normal sperm formation and Leydig cell division.
Although most men who have testicular cancer regain their fertility within several months, infertility can be a major challenge. This condition is characterized by the lack of sperm in the testes, and the difficulty of conceiving is exacerbated by the fact that the testicles are located outside the abdominal cavity. Hypogonadism and infertility may be temporary, but may lead to serious health problems if left untreated.
The increased risk of hypogonadism following childhood cancer treatment is unknown. However, it is possible to avoid the condition by taking steps to prevent or treat cancer before it starts. The study design evaluated the risk of hypogonadism in male CCS using a case-control study. Researchers conducted a prospective cohort study in a clinic setting, with 151 CCS subjects voluntarily participating, with 141 healthy fertile men serving as controls. The serum levels of FSH, LH, and free testosterone were monitored.
Prevalence of hypogonadism in men with testicular cancer
Hypogonadism is a common side effect of testicular cancer treatment. The condition results from a reduction in testosterone and spermatogenesis, and can affect a man's overall sense of well-being. It's also associated with an increased risk of osteoporosis and cardiovascular disease. This condition can be life-threatening.
The median age of a patient diagnosed with testicular cancer is 33 years, but survivors are often young men with no family history. After successful treatment, patients can expect to live for 40 to 50 years. However, they must be aware that the disease can have adverse side effects that affect fertility.
The incidence of hypogonadism is higher among older men. It's not known what causes this condition, but age, obesity, and co-morbidity are known risk factors. Men over 40 years of age, for example, are at higher risk of developing hypogonadism than men with smaller testes.
Other risk factors that may contribute to hypogonadism include metabolic disorders and obesity. Men with hypogonadism who are obese should attempt to lose weight. This will reduce oestrogen levels and restore normal levels of gonadotropins.
Patients diagnosed with hypogonadism must undergo routine monitoring of their testosterone levels and haematocrit. This is important because untreated hypogonadism significantly increases mortality and re-admission rates.
Conclusion
Although most patients with testicular cancer survive the disease, there are some risks that may come with treatment, including hypogonadism and decreased fertility. However, there is evidence that treatment can improve fertility and reduce the incidence of these issues.
One common treatment modality for men with testicular cancer is radiation therapy. This therapy can be applied to the testicles and is particularly useful in treating retroperitoneal metastases. While the testicles are typically protected by gonadal shielding, scatter radiation still has gonadotoxic effects on the testes. However, radiation doses may be as low as 0.28%, which can preserve fertility. XRT can affect testicular function in a dose-dependent manner, and cranial XRT may interfere with hormone secretion.
Hypogonadism is common after radical orchiectomy. While men with hypogonadism may experience infertility, partial orchiectomy can help preserve fertility. In addition, partial orchiectomy is an excellent treatment option for men suffering from solitary or bilateral testicular neoplasms.
In addition to impaired fertility, men with hypogonadism may experience impaired sexual function. Additionally, they may experience fatigue and decreased energy. Furthermore, hypogonadism can lead to osteoporosis and depression. Hypogonadism may also contribute to metabolic syndrome and cardiovascular disease.
Although RPLND is performed as a primary treatment for testicular cancer, it has a significant risk of infertility. This surgical procedure disrupts the hypogastric plexus and retroperitoneal sympathetic nerves. Modern nerve-sparing techniques have reduced the risk of ejaculatory dysfunction following this surgery.
