China Medical University Hospital, Department of Urology
Director Chi-Ping Huang
Doctor Hung-chieh Chiu

Mr. Li started experiencing hypodynamia after turning 50 years old; he gets sleepy in the afternoon and no longer has any enthusiasm for work. His frequency of Nocturnal penile tumescencea is reduced and he is unable to maintain sex life with his wife. He went to the China Medical University Hospital - Department of Urology for medical treatment. Doctor Hung-chieh Chiu conducted an “Androgen Deficiency Self-Evaluation Scale” as the preliminary evaluation and discovered his symptoms matched the “Aging Male Syndromes.” As for blood drawing test, the results revealed that his androgen was only 250ng/dl (normal value 300-1000ng/dl), and hence Mr. Li underwent Hormone Replacement Therapy. After receiving the therapy, he has substantially improved in terms of physique and spiritual aspect. Nonetheless, Doctor Hung-chieh Chiu stated that Taiwan has entered Level 3 COVID alert due to raging COVID-19 virus, which stopped many patients from receiving the hormone therapy in the hospital because of fear. Consequently, the symptoms of androgen deficiency appear again. 

Doctor Hung-chieh Chiu pointed out that there is correlation between hormone replacement and thrombus, so patients receiving AZ vaccination can continue to receive Hormone Replacement Therapy since the probability of thrombus incident is under 1/100,000. Additionally, hormone replacement (controlled within the normal range) can also reduce cardiovascular diseases and improve endothelial cell of blood vessel and metabolic syndrome. In sum of all information, the advantages of vaccination still outweigh the disadvantages. 

Some patients asked why the majority of groups having thrombus after getting vaccine are middle aged people, which deviates from the traditional recognition of the prone group for thrombus consisting elderly people? Doctor Hung-chieh Chiu expressed the reason being the different mechanisms generated by the two types of thrombus. Usually when the blood becomes too viscose, the thrombus generated mainly takes place in deep veins and veins of lower limbs. However, the thrombus generated by vaccine is inducted from “autoimmunity reaction” with complications of thrombocytopenia, also known as VITT (Vaccine-Induced Immune Thrombotic Thrombocytopenia). The area with thrombus also differs from the traditional thrombus, which is mainly distributed on the meningeal veins. 

Additional, there are few thousand cases diagnosed with prostate cancer in Taiwan each year. Many patients are diagnosed with prostate cancer stage 4 with complication of bone Metastasis. Department of Urology Director Chi-Ping Huang mentioned that such patient would receive hormone therapy and can control the progression of prostate cancer through the simulation of androgen deprivation. Clinically, the common side effects for receiving hormone therapy include: hot flushes, weight gain, fatigue and powerlessness, erectile dysfunction, distending pain in breast, osteoporosis, and liver dysfunction. Nonetheless, most patients do not experience serious side effects. 

For example, 75-year-old patients with prostate cancer and complicated Bone metastasis are in real need for COVID0-19 vaccination. Director Chi-Ping Huang stated that the percentage of critical conditions for elderly patients with medical history of cancer infected with COVID-19 could reach as high as 20%. Regardless of receiving hormone therapy or radiotherapy, it is even suggested by National Comprehensive Cancer Network (NCCN) guidelines that such patients should be vaccinated immediately once the vaccines become available. 

Director Chi-Ping Huang indicated that patients with prostate cancer can still receive hormone therapy if they get an AZ vaccine. It is recommended to consult with the doctor for evaluation, regardless of receiving oral or injection type of hormone therapy. Patients are advised to get COVID-19 vaccines soon possible if there is no any other concern after evaluation.