Almost a quarter of men treated for cancer in their childhood suffer from a deficiency of the male sex hormone testosterone. The deficiency can be treated with hormone supplements if the problem is diagnosed. However, this happens all too rarely, as doctor Patrik Romerius shows in his thesis.
Testosterone deficiency not only affects sex drive: in the long term it can lead to depression, reduced muscle strength, osteoporosis, type 2 diabetes, high blood pressure and cardiovascular diseases.
"But if a young man comes to the health centre and complains of low libido and depression, this might be explained as the psychological effects of the cancer he had when he was younger. In actual fact it may be due to a hormone reduction that can be treated," says Patrik Romerius.
In one of his studies he examined 150 men who had been treated for leukaemia and other forms of cancer before reaching adulthood. He found that 33 of them had testosterone deficiency, but that this had only been diagnosed in 4 cases. Patrik Romerius believes that the reason for this is that it is a new patient group.
"Just a few decades ago, very few childhood cancer patients survived. Now almost 4 in 5 recover as a result of better diagnosis and treatment methods. But it is only now that the large groups of childhood cancer survivors have reached an age where the consequences of the treatment are starting to be seen," he says.
The majority of the former cancer patients who were suffering from hormone deficiency were also infertile because the cancer treatment had impaired their sperm production. During and after puberty, young men can provide sperm samples that are frozen and saved, but before puberty, boys do not produce sperm. The only option then is to remove testicular tissue to be preserved for the future.
Today it is not possible to extract sperm from such tissue, but this has been achieved in animal experiments and could become possible in humans in the future. However, removing testicular tissue involves a separate operation before the actual cancer treatment -- a further strain for the young cancer patient.
The research group has produced a genetic marker that makes it possible, by means of a simple blood test, to identify which patients are at highest risk of losing their sperm production entirely and should therefore be offered the operation.
- Male reproductive function in long-term survivors of childhood cancer. Journal of Clinical Endocrinology and Metabolism, 2009
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