When heading to my urologist for my 5-year check-up for testicular cancer I wasn’t concerned at all from a cancer standpoint. Just two weeks earlier, I had returned from a spring break trip with my girlfriend and her daughter so I was completely relaxed. In fact, being a huge self-advocate, I had already requested my medical records from my CT scans, chest X-ray and tumor marker blood tests that I had a few days earlier so I knew all was fine. All that was left was the physical exam. However, in the preceding few months, I was feeling physically worse than any time since my diagnosis. Unbeknownst to me, I was suffering from a perfect storm.
For months, it was almost as if I was in a severe depression or fog. I was constantly exhausted, couldn’t handle the least bit of stress and even put on some weight. As a hospital-based clinical pharmacist, I could barely make it through the workday. I would come home and fall asleep immediately after dinner. I was living with my girlfriend and her daughter at the time and even if I was asked something as simple as what I wanted for dinner, I would freak out. I couldn’t handle having to make any more decisions than the ones I had to make at work. I was angry too, as I hated that I would have weekends off as all I would do was sleep from Friday night until Monday morning.
Luckily, I was aware that testicular cancer survivors can suffer from hypogonadism (low testosterone) which has been reported to lead to increased risk of cardiovascular disease, reduced sexual functioning such as erectile dysfunction, fertility problems, muscle weakness, hot flashes, osteoporosis, loss of energy, and depression. These symptoms of low testosterone were very similar to what I was experiencing so as part of my check-up labs I had asked my urologist if we could check my testosterone level. Heading into the appointment I knew that my testosterone level came back low so I was prepared to discuss the results with my urologist and get started on testosterone replacement right away.
During the appointment, my urologists acknowledged that my testosterone level was indeed low and then he initiated a more in-depth conversation. How was I feeling? What were my symptoms? Was I having any sexual issues? I admitted that perhaps my erections, while achievable, were not as vigorous or long lasting as they had been but that it could be a normality of just getting older.
I was astonished when the urologist refused to start me on testosterone replacement. In fact, he said that while my level was low, that he thought that my symptoms may have something to do with it being the end of a long winter and that I may just not like my girlfriend. What? Winter? Girlfriend? I had lab values that showed that my testosterone was slightly low. Why was he doing this to me? Why wouldn’t he treat me?
I went home somewhat confused and somewhat angry and figured if my symptoms continued that I would find a different doctor for a second opinion. However, the next thing I knew, I was starting to feel better. In fact, even in the two weeks from returning from Florida for spring break and my urologist appointment I was already starting to feel a bit better. Maybe my urologist was right?
Winter was ending and I had always had a bit of a non-diagnosed seasonal affective disorder, becoming somewhat depressed towards the end of winter. There is also some data showing that testicular cancer patients can suffer from vitamin D deficiency with symptoms of fatigue and depression. Plus, low vitamin D levels can be a consequence of living in a northern hemisphere during the winter.
My symptoms eventually resolved and while I still have some signs of testosterone deficiency, such as hot flashes, one would be hard fought to say that my symptoms really necessitate the potential risks of testosterone replacement. Perhaps I was suffering the perfect storm of slightly low testosterone, a tad of seasonal affective disorder, a little vitamin D deficiency and for the record, my relationship with my girlfriend ended. When we are not feeling well we tend to think that there must be one cause. Thankfully, my urologist looked at me as a whole patient and wasn’t looking for that one cause but rather a combination that may have brewed into a perfect storm. Perhaps my urologist is a genius.
Mike Craycraft is a clinical pharmacist, testicular cancer survivor, and founder of the Testicular Cancer Society. He attended Xavier University and then graduated with a B.S. in Pharmacy from the University of Cincinnati. He is a Mentor Angel with Imerman Angels, a 4th Angel Mentor with The Scott Hamilton CARES Initiative at the Cleveland Clinic, and a Survivor Mentor for myCancerConnection at MD Anderson Cancer Center. He is a Research and Community Outreach Fellow for the Men’s Health Initiative, and volunteers for bone marrow registry drives with Love Hope Strength. As a Huffington Post blogger he contributes on issues relating to adolescent and young adult oncology.