Reviewed by Harveer Parmar, MD, Family Medicine, Health Express Clinics, Lewisville, TX
Chemotherapy and radiation therapy can take a profound toll on the human body—especially in male cancer survivors, where one of the most overlooked side effects is hypogonadism, or low testosterone. For many men in the Dallas-Fort Worth area recovering from cancer treatment, symptoms like fatigue, low libido, muscle loss, and mood swings persist long after remission.
At Health Express Clinics in Lewisville, we often see male cancer survivors asking: Is testosterone replacement therapy (TRT) safe for me? Can it help me feel like myself again? This article will answer these questions and more—clarifying when TRT is appropriate, when it’s contraindicated, and how to approach this therapy thoughtfully and safely in cancer survivors.
What Is Testosterone Replacement Therapy (TRT)?
Testosterone Replacement Therapy is the medical process of supplementing low testosterone levels using injectable, topical, oral, or pellet-based formulations.
While often associated with anti-aging or performance enhancement, TRT plays a legitimate medical role in improving the quality of life in men with clinically diagnosed testosterone deficiency—particularly after cancer treatment.
Why Does Cancer Treatment Lower Testosterone?
Cancer therapies can affect testosterone production in several ways:
- Chemotherapy may damage Leydig cells in the testes, impairing hormone production.
- Radiation therapy (especially to the pelvic or testicular region) can suppress the hypothalamic-pituitary-gonadal (HPG) axis.
- Prolonged use of steroids, narcotics, or certain targeted cancer drugs (e.g., Lupron, Zytiga) can suppress endogenous testosterone.
- Testicular or prostate cancer surgery may physically remove testosterone-producing tissue.
Even after remission, testosterone levels may not recover naturally—leaving many survivors with persistent hypogonadal symptoms.
Symptoms of Low Testosterone After Cancer
At Health Express Clinics, we screen cancer survivors who present with:
- Persistent fatigue and low energy
- Decreased libido or sexual dysfunction
- Mood changes, including depression or anxiety
- Muscle loss and increased body fat
- Poor concentration and brain fog
- Loss of bone density
These symptoms are not simply “normal aging” but can reflect androgen deficiency, which is treatable in select survivors.
When Is TRT Beneficial for Cancer Survivors?
✅ Situations Where TRT May Be Beneficial:
- Testicular Cancer Survivors (Post-Orchiectomy)
If both testicles are removed or damaged, testosterone production may be permanently reduced. TRT is often necessary for long-term hormonal balance. - Hematologic Cancer Survivors (e.g., Lymphoma, Leukemia)
These cancers do not have hormone-sensitive pathways like prostate cancer. If remission is achieved and there’s no contraindication, TRT can help restore vitality. - Post-Chemotherapy Hypogonadism
If chemotherapy has led to permanent hypogonadism (as confirmed by labs on multiple occasions), TRT may alleviate fatigue, mood symptoms, and muscle loss. - Bone Health Restoration
In cancer survivors with osteopenia or osteoporosis, TRT may be part of a broader bone health recovery plan, as it promotes bone mineral density. - Quality of Life Considerations
For older survivors who meet the criteria for hypogonadism and have stable disease or remission, improving quality of life through TRT can be ethically and medically justified.
When Is TRT Contraindicated?
❌ Situations Where TRT Should Be Avoided or Used with Caution:
- Active or Recurrent Prostate Cancer
Testosterone can stimulate the growth of prostate cells. Men with prostate cancer (especially metastatic or high-risk types) are typically contraindicated for TRT. - Breast Cancer in Males
Male breast cancer can be hormone-sensitive. TRT may raise estrogen levels via aromatization, posing risks of recurrence. - Polycythemia (Hematocrit >54%)
TRT can increase red blood cell counts, raising the risk of thromboembolic events. - Severe Untreated Sleep Apnea
TRT may worsen sleep apnea in some patients, compounding cardiovascular risks. - Uncontrolled Cardiovascular Disease
While some studies suggest TRT is safe in stable heart disease, uncontrolled CHF or recent stroke/MI should delay therapy. - Fertility Preservation in Young Survivors
TRT suppresses the HPG axis and can impair sperm production. In young men desiring fertility, alternatives like hCG or clomiphene citrate may be preferred.
Clinical Approach at Health Express Clinics
At Health Express Clinics in Lewisville, our approach is thorough and personalized:
Step 1: Confirm Diagnosis
We test total testosterone, free testosterone, LH, FSH, and SHBG, ideally in the morning and on two separate occasions.
Step 2: Cancer History Review
We consult with your oncologist, review cancer type, recurrence risk, and current status (active, remission, or cured).
Step 3: Imaging or PSA Testing
For prostate cancer survivors or those over 50, we screen with PSA and digital rectal exams (DRE).
Step 4: Discuss Risks and Alternatives
We explore both TRT and non-testosterone strategies, including lifestyle, sleep, resistance training, and in some cases, selective estrogen receptor modulators (SERMs).
Step 5: Begin Low and Monitor
If TRT is started, we initiate with conservative dosing and monitor hematocrit, estradiol, PSA, and symptom improvement every 3–6 months.
Top 5 Questions Cancer Survivors Ask About TRT
1. Is testosterone therapy safe after cancer?
It depends on the type of cancer. TRT is generally considered safe in men with testicular or hematologic cancers in remission. However, it is contraindicated in prostate or breast cancer without oncology clearance.
2. Will TRT increase my risk of cancer recurrence?
There is no conclusive evidence that TRT increases cancer recurrence in non-hormone-sensitive cancers. However, patients with a history of prostate cancer must be evaluated individually.
3. How soon can I start TRT after chemotherapy?
Once testosterone levels are confirmed low and remission is established, TRT may be considered 3–12 months post-chemo, depending on recovery and labs.
4. Can I preserve fertility while on TRT?
No. TRT suppresses sperm production. For fertility preservation, alternatives like clomiphene citrate or hCG are used instead of testosterone.
5. What are the risks of TRT for cancer survivors?
Potential risks include polycythemia, prostate enlargement, acne, mood changes, and fluid retention. These are managed through careful monitoring and dose adjustments.
A Hypothetical Patient Scenario
John, age 49, completed chemotherapy for lymphoma 18 months ago. He presented to our clinic with extreme fatigue, low libido, and brain fog. Labs showed consistently low testosterone and elevated LH/FSH, confirming primary hypogonadism.
After oncology clearance, we initiated TRT using topical gel. Over the next 3 months, John reported dramatic improvements in mood, sleep, and energy. We monitored hematocrit and PSA every 3 months, keeping safety our top priority.
Local Relevance in Texas
In the Dallas-Fort Worth area, we’re seeing more long-term cancer survivors thanks to advances in treatment. However, many of these men are left with unaddressed hormonal imbalances that impact their daily life, relationships, and productivity.
Unfortunately, many local providers overlook testosterone screening in survivorship care plans. At Health Express Clinics, we believe survivorship should include hormonal optimization—when it’s safe, evidence-based, and tailored to the patient’s needs.
Summary: Regaining Strength, Safely
Testosterone Replacement Therapy can be life-changing for the right cancer survivors. It helps restore energy, mood, muscle mass, and sexual health—but only when used with clinical precision and oncologic guidance.
At Health Express Clinics in Lewisville, we treat the whole patient—not just the lab numbers. If you’re a cancer survivor struggling with fatigue, mood issues, or low testosterone symptoms, let’s talk about your options.
Author Byline:
Reviewed by Harveer Parmar, MD, Family Medicine, Health Express Clinics, Lewisville, TX.