Serum testosterone levels in surgeons during major head and neck cancer surgery: a suppositional study.

Serum testosterone levels are known to have diurnal variation and to decrease by up to 2% per year after the age of 40. They can also be affected by stress and aggressive behaviour as well as various medical conditions. Although studies have investigated the role of mood and stress, none has specifically evaluated the effect of operative procedures on surgeons testosterone levels, particularly those in our own specialty, one that has historically been associated with perceived 'high testosterone' levels. We devised a suppositional study, particularly pertinent for publication at the beginning of April. This was a prospective randomised study of five male consultant maxillofacial surgeons (including two with male pattern baldness) and assayed serum testosterone levels at rest, during, and after a series of major ablative and reconstructive procedures. The resting testosterone levels were found to be similar in all surgeons (220 ± 120.9 mcg/ml). During major head and neck procedures, a statistically significant increase in serum testosterone was found (up to a maximum concentration of 1062.50 mcg/ml). Multivariate analysis revealed that the likely predictors of increasing serum testosterone were: size and extent of tumour and complexity, and type of microvascular reconstruction (all P<0.001). The long-term effects of chronically raised serum testosterone warrant further investigation but recent evidence has found that it may be cerebro-protective against conditions including Alzheimer's syndrome.