ASCO 2017: Low Testosterone Level After Testicular Cancer Is Common, Linked to Chronic Health Problems

Key Points

  • Being overweight or obese was associated with a higher chance of having low testosterone levels, as was older age.
  • The researchers also found a genetic abnormality (in the sex hormone–binding globulin gene) that appears to predispose some men to low testosterone levels, but this needs to be confirmed in larger studies.
  • Survivors participating in vigorous physical activity appeared to have higher levels of testosterone.

In a large study, 38% of 491 testicular cancer survivors had low testosterone levels. Compared with survivors with normal testosterone levels, survivors with low testosterone levels were more likely to have a range of chronic health problems, including high blood pressure, diabetes, erectile dysfunction, and anxiety or depression.

The study was presented by Zaid et al at the 2017 ASCO Annual Meeting (Abstract LBA10012).

“Because testicular cancer occurs at a young age and is highly curable, many survivors may live upward of five decades,” said lead study author Mohammad Issam Abu Zaid, MBBS, Assistant Professor of Medicine at the Indiana University School of Medicine in Indianapolis. “Our findings underscore the need for clinicians to assess testicular cancer survivors for physical signs or symptoms of hypogonadism and to measure testosterone levels in those who do.”

Low testosterone levels can be present at the time of a testicular cancer diagnosis or develop as a side effect of surgery or chemotherapy. Although it has been known that low testosterone levels occur in a significant proportion of testicular cancer survivors, this is one of the first studies to examine its relationship with long-term health complications in North American patients.

The Platinum Study

This analysis comes from the first 491 patients enrolled in The Platinum Study, which aims to be the largest study of testicular cancer survivors worldwide, with over 1,600 survivors already enrolled and still actively recruiting. All patients received chemotherapy and were younger than age 55 when they were diagnosed with cancer. The median age at clinical evaluation was 38 years.

The goal of the Platinum Study is to follow the lifelong health of men who received cisplatin chemotherapy for testicular cancer. Researchers collect health information through comprehensive questionnaires and blood samples, as well as basic measurements like blood pressure and a hearing test. The study also aims to identify genes that may raise the chance of developing long-term health problems, such as nerve damage and hearing loss.

Key Findings

Among the 491 survivors, 38% had a low testosterone level or were on testosterone replacement therapy. Being overweight or obese was associated with a higher chance of having a low testosterone level, as was older age. The researchers also found a genetic abnormality (in the sex hormone–binding globulin gene) that appears to predispose some men to low testosterone levels, but this needs to be confirmed in larger studies. Survivors participating in vigorous physical activity appeared to have higher levels of testosterone.

Compared with survivors with normal testosterone levels, testicular cancer survivors with low testosterone levels were more likely to take medicine for:

  • High cholesterol (20% vs 6%)
  • High blood pressure (19% vs 11%)
  • Erectile dysfunction (20% vs 12%)
  • Diabetes (6% vs 3%)
  • Anxiety or depression (15% vs 10%).

“Some of these health problems have been previously linked to low testosterone levels among men in the general population and in a few studies of testicular cancer survivors, but this study is one of the most comprehensive to date—we are looking at 15 different health conditions,” said Dr. Abu Zaid.

Commentary

“We can now cure 19 out of 20 cases of testicular cancer, but a significant number of testicular cancer survivors have low testosterone, and that can affect other aspects of their health. Based on this study and others, clinicians should ask testis cancer survivors whether they have symptoms of low testosterone and should watch for signs of associated health problems,” said Timothy D. Gilligan, MD, MSc, an ASCO expert.

This study was funded by the National Institutes of Health.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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