Can testosterone improve after testicular cancer?

Question

Hello doctor,

My husband is an active-duty pilot and was recently chosen to transfer to a different military branch. He had three rounds of BEP chemotherapy and had one testicle removed because of testicular cancer.

While we were trying to conceive, his hormone levels were checked regularly. After surgery, his testosterone was 390, then dropped to 237 after six months, and is now 267. His free testosterone is 47.9, and SHBG is 23, both in the normal range. Because of the earlier low testosterone result, the new branch has disqualified him for hypogonadism unless he starts testosterone therapy and keeps his levels stable for 90 days. But if he starts therapy, he would not be eligible to stay in his current branch.

I have read that hormone levels can keep improving for up to 24 months after chemotherapy. With this in mind, we want to know if his current levels clearly show hypogonadism, or if an endocrinologist might decide he does not have it and could still improve.

He does not have any symptoms of low testosterone.

Kindly help.

Thank you for your time and guidance.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and understand the concern.

Your husband does not have clinical hypogonadism from a medical point of view. His total testosterone is a little low, but his free testosterone and Sex hormone-binding globulin (SHBG) levels are normal, and he does not have any signs of androgen shortage. To make a diagnosis, testosterone levels must be persistently low, and there must be symptoms that go along with it. Laboratory results by themselves, especially total testosterone levels, are not enough to make a diagnosis.Endocrinology guidelines do not suggest diagnosing hypogonadism or commencing testosterone therapy if free testosterone levels are normal and there are no symptoms. His hormone levels are in line with what would be expected after having one testicle removed and having Bleomycin, Etoposide, and Cisplatin (BEP) chemotherapy. Over time, the surviving testicle usually makes up for the loss, and Leydig cell activity may slowly return to normal after cisplatin-based treatment. This procedure can take 12 to 24 months or longer, and it usually improves over time.

It has been 13 months since your husband completed chemotherapy, so he remains within the expected recovery period. His testosterone levels may continue to stabilize or improve. Starting testosterone therapy now could slow his natural recovery, reduce fertility, and impact the function of his remaining testicle.

Given his lack of symptoms, normal free testosterone, and ongoing recovery, an endocrinologist would likely conclude he does not have hypogonadism at this time. Testosterone therapy is not indicated. Continued monitoring through regular check-ups is recommended. This approach is supported by medical evidence, particularly when the primary goal is health assessment for work rather than treatment.

I hope this explanation helps.

If you have more questions, please feel free to ask.

Thank you.