Gonadal Hormones in Long-Term Survivors 10 Years after Treatment for Unilateral Testicular Cancer (original) (raw)
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Fundamental Aspects of Hypogonadism in the Aging Male
Reviews in Urology, 2003
With aging in men, serum testosterone levels decline progressively and the prevalence of hypogonadism increases; these changes are associated with alterations in androgen-regulated physiological functions. In young hypogonadal men, similar alterations improve with testosterone replacement. In older men, short-term testosterone treatment trials suggest benefits (eg, on body composition and bone mineral density), without significant adverse effects. Therefore, androgen deficiency may contribute to physiological decline with aging, and testosterone therapy is reasonable for older men with clinical manifestations of androgen deficiency and low testosterone levels. However, the long-term benefits and potential risks (eg, for prostate disease) of testosterone treatment in older men are unknown.
High risk of hypogonadism in young male cancer survivors
Clinical Endocrinology, 2018
Objective: Cancer and its treatment in childhood and young adulthood can cause hypogonadism, leading to increased risk of long-term morbidity and mortality. The aim of this study was to evaluate the risk of presenting with biochemical signs of hypogonadism in testicular cancer survivors (TCS) and male childhood cancer survivors (CCS) in relation to the type of treatment given. Design: Case-control study. Patients: Ninety-two TCS, 125 CCS (mean age 40 and median age 34 years, respectively; mean follow-up time 9.2 and 24 years, respectively) and a corresponding number of age-matched controls. Measurements: Fasting morning blood samples were analysed for total testosterone (TT), follicle-stimulating hormone (FSH) and luteinizing hormone (LH). The odds ratios (OR) for hypogonadism, defined as primary, secondary, compensated or ongoing androgen replacement, were calculated for TCS and CCS and for subgroups defined by diagnosis and treatment.
Testosterone for the aging male; current evidence and recommended practice
Clinical Interventions in Aging, 2008
An international consensus document was recently published and provides guidance on the diagnosis, treatment and monitoring of late-onset hypogonadism (LOH) in men. The diagnosis of LOH requires biochemical and clinical components. Controversy in defi ning the clinical syndrome continues due to the high prevalence of hypogonadal symptoms in the aging male population and the non-specifi c nature of these symptoms. Further controversy surrounds setting a lower limit of normal testosterone, the limitations of the commonly available total testosterone result in assessing some patients and the unavailability of reliable measures of bioavailable or free testosterone for general clinical use. As with any clinical intervention testosterone treatment should be judged on a balance of risk versus benefi t. The traditional benefi ts of testosterone on sexual function, mood, strength and quality of life remain the primary goals of treatment but possible benefi cial effects on other parameters such as bone density, obesity, insulin resistance and angina are emerging and will be reviewed. Potential concerns regarding the effects of testosterone on prostate disease, aggression and polycythaemia will also be addressed. The options available for treatment have increased in recent years with the availability of a number of testosterone preparations which can reliably produce physiological serum concentrations.
European Journal of Cancer, 2011
Introduction: This study investigates the pituitary-Leydig cell axis in patients with stage I testicular germ cell cancer (TGCC) followed with surveillance only, in order to evaluate the risk of Leydig cell dysfunction one year after orchiectomy. Patients and methods: A retrospective evaluation of reproductive hormones in patients with unilateral stage I TGCC (N = 72) without relapse diagnosed between 1990 and 2008. A group of healthy males (N = 706) served as controls.
Testosterone deficiency in testicular cancer survivors – a systematic review and meta-analysis
SUMMARY Results concerning treatment of Testicular Germ Cell Cancer (TGCC) and subsequent risk of testosterone deficiency are conflicting. To systematically evaluate and estimate the risk of testosterone deficiency (TD) in TGCC-patients according to treatment to optimize follow-up and for prevention of late effects related to hypogonadism. We performed a critical review of PubMed in January 2015 according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. Twelve publications were selected for inclusion in this analysis. Eleven studies evaluated the risk of TD in TGCC-patients treated with standard chemotherapy (CT) and the odds ratio for TD was 1.8 (95% CI) (1.3–2.5), (p = 0.0007). Seven studies evaluated the risk of TD in TGCC-patients treated with non-conventional therapy and the odds ratio for TD was 3.1 (95% CI) (2.0–4.8), (p < 0.0001). Six studies evaluated the risk of TD in TGCC-patients treated with infradiaphragmatic radiotherapy (RT), and the odds ratio for TD was 1.6 (95% CI) (1.0–2.4), (p = 0.03). In all treatment groups the risk of TD was compared with TGCC-patients treated with orchiectomy alone. There was no indication of heterogeneity between studies in the three treatment groups. Strong evidence exists that standard CT, non-conventional therapy and infradiaphragmatic RT are associated with an increased risk of TD in TGCC-patients when compared with orchiectomy alone. The risk of testosterone defficiency appears to be highest in patients treated with non-conventional therapy.
Impaired in vitro Testicular Endocrine Function in Elderly Men
Andrologia, 2009
Measurements of testosterone concentrations in peripheral and spermatic venous blood have yielded conflicting results concerning testosterone production in elderly men. To further elucidate the testicular endocrine capacity during aging, peripheral serum hormone levels and the in vitro conversion of progesterone and pregnenolone in histopathologically normal testicular tissue have been investigated in 22 elderly men and 28 younger adult males. The conversion mediated by 30-hydroxysteroid-dehydrogenase and 17a-hydroxylase was significantly higher (p < 0.05 and p < 0.01 respectively) in testicular tissue from the younger adult men, than in testicular tissue from elderly men. Since serum LH levels were significantly higher (p < 0.01) and serum testosterone levels were significantly lower (p < 0.01) in the elderly men, these data indicate that there was a primary endocrine impairment at the testicular level in the elderly men. In vitro-Beeintrachtigung der endokrinen Hodenfunktion beim alteren Mann Zusammenfassung: Messungen der Testosteronkonzentration im peripheren Blut und im Venenblut der V. spermatica haben widerspriichliche Resultate hinsichtlich der Testosteronproduktion des alteren Mannes ergeben. Daher wurden zur weiteren Auildarung der endokrinen Kapazitat des Hodens im Alter bei 22 dteren Mannern und bei 28 jiingeren Erwachsenen (18-49 Jahre alt) die peripheren Serum-Hormon-Werte als auch die in vitro-Conversion von Progesteron und Pregnenolon bei histologisch normalem Hodengewebe untersucht. Die Conversionvermittelt durch 30-Hydroxysteroid-dehydrogenase und 17a-Hydroxylasewar signifiant hoher (p < 0,05 bzw. p < 0,Ol) im Hodengewebe von jiingeren erwachsenen Mannern als im Hodengewebe von dteren Mannern (60-83 Jahre). Da die Serum-LH-Werte signifikant hoher (p < 0,Ol) und die Serum-Testosteron-Werte signifikant niedriger (p < 0,Ol) bei alteren Mannern waren, bedeuten diese Daten, dat3 es sich bei den alteren Mannern um eine primare endokrine Beeintrachtigung der Hodenfunktion handelt.
Risk factors for post-treatment hypogonadism in testicular cancer patients
European Journal of Endocrinology, 2008
Objectives: Testicular germ-cell cancer (TGCC) patients are at risk of developing hypogonadism but no risk factors have yet been defined. Methods: Blood was collected from 143 TGCC patients (after orchidectomy, prior to further therapy (T0) and 6, 12, 24, 36 and 60 months (T6, T12, T24, T36 and T60) after therapy). Biological hypogonadism (BH) was defined as: serum testosterone below 10 nmol/l and/or LH O10 IU/l; odds ratios (ORs) for BH with BH at T0, age, stage of disease, testicular characteristics, and androgen receptor polymorphism as predictors were calculated as well as the OR for developing BH post-treatment (one to two cycles of adjuvant chemotherapy (ACT) versus three to four cycles of higher dose chemotherapy (HCT) versus adjuvant radiotherapy (RT)). Results: HCT increased the OR for BH at T6 (OR 22, 95% confidence interval (CI) 4.4-118) and T12 (OR 5.8,. RT increased the OR at T6 (OR 10, 95% CI 2.1-47) and at T12 (OR 3.9, 95% CI 1.1-14). Microlithiasis predicted BH at T0 (OR 11, 95% CI 1.2-112), T12 (OR 3.9, 95% CI 1.1-13), T24 (OR 3.0, 95% CI 1.0-8.8), T36 (OR 5.4, 95% CI 1.7-17) and T60 (OR 4.4,. BH at T0 was a risk for BH at T6 (OR 53, 95% CI 19-145), T12 (OR 125, 95% CI 37-430), T24 (OR 88, 95% CI 26-300) and T36 (OR 121, 95% CI 32-460). Conclusions: It is clinically relevant that BH at T0 and testicular microlithiasis were predictive factors for post-treatment BH. HCT and RT gave temporary BH.