Survivorship: Health Concerns After Orchiectomy

Treatment for testicular cancer typically includes the removal of one or both testicles. This is called orchiectomy. The testicles are responsible for producing and storing sperm and producing the male hormone testosterone.

Low Testosterone (Hypogonadism)

If you have had one or both testicles removed, you may be at risk for hypogonadism (producing little or no testosterone). This risk is higher if you have both testicles removed. Low levels of testosterone can cause:

• Infertility, erectile dysfunction, and decreased sex drive (libido).
• Fatigue, muscle loss, or weakness.
• Gynecomastia (enlargement of breast tissue).
• Less beard and body hair growth.
• Being overweight.
• High blood pressure.
• Osteoporosis (weakening of your bones).

You should be checked for hypogonadism using blood tests that check testosterone, FSH (follicle-stimulating hormone), and LH (luteinizing hormone) levels. These are hormones that stimulate the testes to make testosterone. You may need to take testosterone, which you can speak to your care provider about.

Sexual Health

The loss of a testicle can challenge how you feel about your body; especially when it comes to sexual relationships. Changes to your body can impact your desire to have sex and the pleasure you get from having sex. Be sure to talk with your partner about the changes to your body and how you might be feeling about sex and your body. Sex therapists can be helpful if you are having trouble talking with your partner or being intimate after an orchiectomy.

Fertility Concerns

Low sperm count can be an issue both before and after cancer treatments. Men often have normal sperm counts within a few years after treatment. You can get a woman pregnant even with low sperm counts, so it is important to use birth control/protection if you do not wish to father a child. If you have had both testicles removed, you can no longer make sperm and will be infertile (unable to get a woman pregnant). If you have had only one testicle removed and you wish to have children, you should ask to speak to a fertility specialist. Losing one testicle has no effect on your ability to get an erection or have sex if your body is making enough testosterone.

Other Health Concerns

If you have had one testicle removed, it is important to protect the remaining testicle during sports by wearing an athletic cup.

A low testosterone level can lead to osteoporosis. The risk is highest if you have both testes removed. You can decrease your risk of developing osteoporosis by getting enough calcium and vitamin D in your diet (or supplements if your diet is lacking) and doing regular weight-bearing exercise. Your provider may order a DEXA scan, which is a test to look at the strength of your bones.