A male undergoing cancer therapy may develop hypogonadism.
Testing for hypogonadism should include free testosterone. An elevated sex hormone binding globulin (SHBG) level may result in the total serum testosterone being in the normal range despite a low free testosterone level.
Risk factors for hypogonadism in a male undergoing cancer therapy:
(1) anti-androgen therapy for prostate or other cancers (intentional hypogonadism)
(2) hypogonadism existing prior to cancer therapy
(3) testicular damage secondary to chemotherapy
(4) testicular damage secondary to radiation therapy
(5) suppression of the hypothalamus-pituitary axis with reduced release of LH
(6) elevated cytokines such as IL-6
(7) cancer cachexia (associated with elevated ghrelin)
The function of the hypothalamus-pituitary axis may be affected by opioid therapy, Ghrelin, brain metastases, chemotherapy or cranial radiation therapy.
If the hypothalamus and pituitary are functioning then serum LH should be elevated if testicular damage is the cause.
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