Don't Overlook the Psychological Impacts of Testicular Cancer

Testicular cancer can significantly impact your mental health, body image and self-identity. It's common for men to feel depressed over losing a testicle, anxious over the diagnosis of cancer and fearful of not being able to father a child, according to S. Adam Ramin, M.D., a urologic surgeon and the medical director of Urology Cancer Specialists in Los Angeles.

"I think particularly for men, younger men in their 20s and 30s, this is a prime period of life where they're trying to establish relationships, families, intimacy, career, and having testicular cancer is a real blow," said Max McMahon, a licensed clinical social worker who works with patients with genitourinary cancers at Dana-Farber Cancer Institute in Boston.

McMahon regularly sees how testicular cancer impacts a man's sense of self-worth. Many men view having a testicle removed—which is the primary testicular cancer treatment—as a form of trauma, disembodiment or emasculation.

"There's a whole myth and fear around castration, and so that's kind of scary to think about," he said, adding that patients may feel a sense of loss of something integral to their body, personhood or manhood.

The psychological impact can be far-reaching, according to Justin Houman, M.D., a reproductive urologist and men's health specialist at Tower Urology in Los Angeles and the medical director for Bastion Health, an app-based telehealth platform for men.

This mental health impact can lead to the following concerns:

• Anxiety and depression. A diagnosis of testicular cancer can be overwhelming and cause a lot of anxiety and stress.
• Body image concerns. The removal of one or both testicles can be a traumatic experience for men and can lead to feelings of inadequacy or embarrassment.
• Sexual difficulties. Testicular cancer can affect a man's sexual function, including his ability to get and maintain an erection or have an orgasm.
• Fear of recurrence. After treatment, many men who beat testicular cancer fear it will return.
• Social isolation. Some men with testicular cancer may feel isolated or like they don't fit in with their peers.
• Financial worries. The cost of cancer treatment can be a significant source of stress for many families.

These fears and feelings aren't unfounded and stem from several external factors that occur during cancer care.

Many factors perpetuate the impact of testicular cancer on a person's mental health. Initially, the cancer diagnosis alone can be traumatic and overwhelming, leading to anxiety, depression and other emotional distress.

Cancer treatment can also be physically and emotionally challenging due to surgeries, chemotherapy and radiation therapy, Houman explained. All of these can have side effects.

"Some of the treatments used to treat testicular cancer can have significant side effects, including fatigue, nausea and changes in sexual function. These side effects can impact a man's quality of life and contribute to feelings of anxiety and depression," he said.

Men who experience difficulty getting an erection or having an orgasm can undergo further distress, McMahon added.

"So there might be avoidance of sex and intimacy because he doesn't want to start something that he can't finish, so to speak," he said, adding that fear around sex begins to escalate instead of the individual feeling in the moment or present with a partner. "I think a real vulnerability occurs with testicular cancer."

Add to that the misconceptions or fears about the disease, including concerns about recurrence, death and infertility. These misunderstandings can contribute to anxiety and distress as well.

"No matter what kind of cancer a person has, they will fear dying from the cancer," Ramin said, stressing that modern treatments for testicular cancer have an excellent cure rate, even for people with late-stage, advanced cancer.

Potential social isolation is another mental health challenge.

"Men with testicular cancer may feel isolated from their peers, particularly if they are young and have not encountered others with the disease," Houman said.

If your partner or loved one has testicular cancer, it's not always easy to know if or when it's starting to impact their mental health. The first clue to look for is any change in their behavior, McMahon said.

"If he's usually social but he's withdrawing—from conversation, social interactions, routines and relationships—and is more temperamental, that's a sign that he could be struggling," he explained.

The individual's behavior often is withdrawal from the outside world and retreat within their own head. They might seem reserved and indifferent. Ramin added this could display as a loss of interest in life, family, leaving the house or doing fun activities.

Testicular cancer can severely impact libido and sexuality. Withdrawal from intimacy is another vital sign.

"If a man is not feeling attractive or not feeling comfortable in his own skin, he may not initiate basic affection, hugs, kisses, a gentle touch with a partner," McMahon explained. "We're not even talking about sexual touch, but just affectionate touch, normal touch in an intimate relationship."

Other telltale signs someone might be struggling psychologically, according to Houman, include the following:

• Sleep disturbances
• Changes in appetite
• Substance use
• Avoidance behaviors
• Physical symptoms, such as headaches, digestive problems or chronic pain

The important point to remember is that if you do notice these changes in your partner and you suspect they may be psychologically impacted by their testicular cancer, there are ways for you to reach out and support them.

McMahon said you should be curious and inquisitive while supporting a partner. Sometimes a partner of a testicular cancer patient avoids the topic because they find it too scary or want to give their partner time and space.

That's OK, but he emphasized that you need to make genuine attempts to reach out. Make comments like, "I'm here and want to talk about it. I want to know what you're thinking." Ask them what their experience has been like. It's good to be communicative and interested and acknowledge that you don't know what they're experiencing.

Encouraging a safe time and space to talk can be supportive.

"One of the most important ways partners can help is by providing emotional support to their loved one," Houman said. "This can involve listening to them, offering encouragement and reassurance, and helping them stay positive and hopeful."

Attending doctor's appointments together is a positive form of support, Ramin added. Just opening up that conversation and offering support to attend appointments can make a big difference.

Simple questions show you are open, adaptable and curious, according to McMahon. Such questions may include:

• Do you want to go alone to this appointment or do you want me to come?
• Do you want to talk about the appointment today?
• Do you want to talk about your results?

"I really encourage partners to be involved in care, ask questions and be part of the decision-making process if the person with testicular cancer wants them to. It can be helpful in the long term," McMahon said.

Houman mentioned a few other ways to help your partner through the psychological impacts of testicular cancer. Assist with daily tasks, for instance. Treatment for testicular cancer can be physically demanding, and men may need assistance with everyday tasks such as cooking, cleaning and transportation. Partners can help by offering practical support and assisting with these tasks.

Partners can assist their loved one in researching treatment options, including surgery, chemotherapy and radiation therapy. This assistance can help ensure your loved one is fully informed about their options and can make informed decisions about their care.

In that vein, encourage self-care activities such as exercise, meditation and relaxation techniques, which can help reduce stress and anxiety.

Take some time to educate yourself about testicular cancer, including the symptoms, treatments and possible side effects. You may be better able to understand your loved one's experience and provide more effective support.

If you are doing all these things in support of your partner, remember to also look after yourself.

"Compassion fatigue or caretaker fatigue can take its toll, so you need to know your bandwidth to handle things and cope," McMahon said. "You have to take care of yourself, too."

Every relationship needs outlets, and each individual has different needs. Realizing both of you might need separate support and outlets is healthy. There are support groups for people living with testicular cancer, for their families and for their partners. You may find your support through a counselor, family member or friend.

It's crucial for each partner to find outlets and support that work for them. If you think a therapist might be able to help you and/or your partner but you don't have one you see regularly, taking the first step can be difficult. Giddy Telehealth takes the difficulty out of the search. The easy-to-use online service provides access to hundreds of healthcare professionals who have expertise across the full scope of medical care. Many of them specialize in mental health and offer same-day video visits.