Hormone treatment for testicular cancer

Men who have lost one testicle due to cancer do not usually need testosterone replacement therapy, also called hormone replacement therapy (HRT). When one testicle has been surgically removed the other testicle produces extra hormones to compensate for what is lost.

However, in rare situations men are advised to have testosterone replacement (HRT). For example, sometimes the remaining testicle is shrunken and so not enough testosterone is produced, and so more testosterone is needed. Testosterone replacement may also be needed if a man is born with just one testicle, and later develops testicular cancer, or if a man has cancer in both testicles.

HRT is recommended in these situations because if testosterone levels are low in later life there may be a decrease in bone mass (osteoporosis), decreased bone marrow activity leading to anaemia (a low blood count), muscle wasting, and a reduction in sexual drive and sperm production. A man’s mood may also be affected.

HRT can be given by mouth, injected into a muscle, implanted as pellets under the skin of the lower abdomen, given via patches on the scrotum or elsewhere on the body, or as a gel. Each method has advantages and disadvantages, and the pros and cons should be discussed with the doctor.

Most men find that HRT is helpful and that it maintains a good quality sex life.

One man interviewed here, aged 39, who had fairly recently had cancer in both testicles, was taking hormone tablets three times a day. He was considering other options, but said that he liked the tablets. He recognised that he would not be able to have any more children, but said that the tablets keep his sex life going.

Explains that he is taking tablets of testosterone because he has had both testicles removed.

Age at interview 39

Gender Male

Age at diagnosis 35

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Now the biggest thing I had was I tend to sweat a lot my cancer man asked me whether or not I’d had any hormone replacement because with, now having both testicles removed then the body has no means of generating them, so you’re gonna need some. Now theres apparently no rush immediately after surgery because the hormones that are generated, last within your body for a fair amount of time. But I’m sweating a lot. My cancer specialist asked me whether or not my other people had done anything in, in that area, so I said No. So I’ve been prescribed tablets of testosterone, which I take three times a day, with meals, and I’m scheduled to see a specialist, I’m waiting for a referral to give me a date where I’ll sit down and discuss what the options are.

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Describes different forms of HRT and explains why the tablets have been beneficial.

Age at interview 39

Gender Male

Age at diagnosis 35

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My information to date, which I believe is quite right, because I’ve spoken to my GP about it, and I seem to know more than he does! Is tablets, you can take three times a day; you have to have them with food. Tablets aren’t ideal; the stomach acids tend to eat them quicker than the body absorbs them. Apparently there is a new one, which is to be, you have with a milky drink, which aids the absorption.

There are injections where, I believe its two to three weeks apart you have the injections. I don’t think I’ll go for that one because I think I’m having my blood tests, I actually want to get those as far apart to actually go back to two weekly ones now. And the third option is a small implant under the skin which I believe lasts for two to three months, which just slowly dissolves and goes through the body, provides the hormone replacement. Hormones in the tablet form, my GP laughs, he says it doesn’t matter if you forget one because it’s not critical! The worst that you can have if you’re not taking a tablet is you sweat a bit is not a problem. But I mean basically it keeps your sex life going, both the, I guess the capability and the desire and it seems to work. I function normally, I have no necessity to worry about buying a bigger house because we will not have any more children, but its all the fun and none of the pain I guess. I don’t know which way I’ll go on hormones. I’m a bit of a coward so to do implants is, is probably not my bag. Although for some people, it lasts three months, its maybe what they want.

Oh, patches are the other one that you can have. But I have been told again by one of my doctors that I see is that patches aren’t necessarily good for a bloke, yeah. Because all blokes are hot and hairy and sweaty so, all the patches tend to fall off!

Right yes.

But I’m quite happy on tablets, it’s something that you have to do.

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A young man, aged 26, born with only one testicle, told us he was offered an HRT gel but didn’t like the idea of rubbing it onto his body, and the possibility that he might rub it onto someone else by mistake. At the time of the interview he was having an intramuscular injection every three weeks. He said that thanks to the HRT injections his sex life was ‘great’. He was considering using a capsule, which would be injected under the skin, which would slowly release testosterone over a period of four months, which would be more convenient if he went travelling.

Explains why he decided not to consider having hormone replacement therapy in the form of a gel.

Age at interview 26

Gender Male

Age at diagnosis 24

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At first I wasn’t that happy because I researched a gel, because it was a year ago I had a phobia of needles, which has definitely gone now. I mean I’m a pincushion anyway but I had this phobia of needles and so I researched about the gel. And this gel you rub it on yourself every day, but you have to be careful when you’re rubbing yourself that if you hug someone or shake someones hand that you don’t get any on him or her, because they could actually absorb the testosterone. And I was reading this and that just freaked me out even more, I was like, oh right that’s your idea of a cure, that I rub myself in this gel and wrap myself in a suit and don’t touch anybody and that just you know it, well it just sounded ridiculous, it didn’t sound like a good cure.

Where did you find that information?

I got that from the hospital.

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Explains that testosterone injections have allowed him to have a normal sex life.

Age at interview 26

Gender Male

Age at diagnosis 24

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Well what I’d like to say is that the injections, the testosterone injections have worked really, really well. I was given a list of side-effects that testosterone injections would have and apart from the fact that you do get the sort of sporadic erections a little more than you would otherwise, I haven’t had any, and my sexual drive, it’s quite ironic, but it’s actually I think for me it’s actually better than it was, and sex has not lost any of its, you know its beauty, it’s still great. And yeah I’ve been quite impressed by that and the injections.

I mean they say that these deep intramuscular injections are very painful but you get used to them and I have one every three weeks and it’s not really painful. I mean occasionally you know the injection can go slightly in the wrong place, or hit a more tender part of your muscle, and you may have a numb leg for like a day but it’s not a big deal at all, and like I said, I’ve just been really impressed, because my testosterone levels were depleting quite rapidly, because I didn’t deal with my cancer and I only had one testicle.

I mean the freakiest thing was that I lost my sex drive, well not completely, but I lost a lot, and yeah, I’ve just been really impressed with the testosterone replacement, it’s really worked well.

The only reason I’m considering the capsule is because I want to go travelling. If I wasn’t considering going travelling then I would be happy to just carry on having injections. But I’m not sure about taking testosterone injections abroad, especially if you’re going somewhere like Thailand

And the capsule under the skin lasts three months?

Yeah the capsule under the skins lasts four months.

How soon after the operation could you start taking the testosterone?

I started the testosterone very soon after the operation, I think it was two weeks after the operation, and it took about eight to ten weeks to reach the testosterone level that was sufficient for my body, and when it reached it, it was great to feel that again.

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A man aged 50, who had lost both testicles, described how he felt before he had HRT. He had tried tablets, skin patches and implanted pellets, but had suffered unwanted side effects. He said that he could usually tolerate a drug called Virormone, a form of HRT that he injected himself under the skin, and he said that HRT had changed his life in a spectacular manner. However, he developed polycythaemia (overproduction of red blood cells), a serious side effect of testosterone treatment (see ‘Side effects of hormone treatment‘).

Explains that he injects himself with Virormone and that HRT is most effective for men who have…

Age at interview 50

Gender Male

Age at diagnosis 39

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I’ve tried all the different sorts of HRT and for various reasons I’ve found that one thing doesn’t agree with me, or the other thing doesn’t work, and I now have a self injectable cannula into my tummy. And every day or so I give myself a little push on a syringe which gives me a hormone cocktail. I get on all right with that; I do it myself, so that’s fine.

So now I self-administer myself with a cocktail of drug called Virormoneâ. Virormoneâ is a testosterone compound with other things in it, mixed in, and I have a cannula which is like a small blood sampling kit that I put into my tummy wall. I deal with it myself, it is very easy, it is painless. Once you’ve done it, once you’ve overcome the hurdle of the very first time it is literally painless. You attach a syringe to it and you give it a squeeze and that way you’re getting the amount of testosterone that you need without having massive overdoses of testosterone.

All I can say is, examine every single option that you are given because you will eventually find what is right for you, and once you find what is right for you, you will be stunned because the change in your life, of getting HRT, is nothing less than spectacular. You will go, within 2 or 3 days you will go from being a tired bear that just wants to hibernate and sleep all day, to someone that has got their vitality back, has got their energy back, that is a nice type of human being to be around.

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Explains how he would feel if he were not having hormone replacement therapy.

Age at interview 50

Gender Male

Age at diagnosis 39

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I know that if I don’t have the hormone or I didn’t have the hormone injections at the beginning, I would have the hot flushes, I would be irritable, I would be extremely fatigued. I say fatigued, not tired – it affects your whole body. When you’re tired you yawn and your brain doesn’t function properly. This was more than that, this was aching in all my limbs, and this was pain in my back and my groin, total fatigue, inability to concentrate on anything more than about 10-15 seconds in duration. So my body was lacking something.

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Occasionally, men who don’t have any testicles can feel well without hormone treatment. One man  described his distress when HRT wasn’t offered. When he was offered HRT, he disliked the side effects, and stopped taking it after several years(see ‘Side effects of hormone treatment‘). When interviewed, aged 52, he said he was managing quite well without HRT.

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