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Hormone and thyroid problems after a bone marrow transplant | CION Cancer Clinics
Hormone problems are among the most common late effects of a bone marrow transplant. The thyroid, ovaries and testes are affected most often, and steroids can raise blood sugar. They can appear months or many years later, and most can be treated by replacing the missing hormone. This guide explains the signs, the tests on your report and when checks usually happen. At CION Cancer Clinics, our haematology team assesses whether a transplant or CAR-T fits your situation and coordinates care with qualified centres.
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Medically reviewed by Dr. Basudev PokhrelConsultant Haematologist · last reviewed September 2026, next review due September 2027
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On this page
- Why can a transplant affect your hormones?
- Which glands are most often affected, and how would you notice?
- What do the hormone tests on your report mean?
- When are hormones usually checked after a transplant?
- What do families often get wrong about hormone problems?
- What can this page not tell you?
- Common questions about hormones after a transplant
The short answer
Why can a transplant affect your hormones?
The strong chemotherapy and, for some people, total body irradiation (radiation to the whole body) given before a transplant can damage the glands that make hormones. The thyroid, the ovaries and the testes are affected most often, and problems can appear months or many years later.
Why it often goes unnoticed
Hormone problems come on slowly. Tiredness, weight gain, low mood, irregular periods or low sex drive are easy to blame on the transplant itself. Many are found only because a routine blood test picks them up before the symptoms become clear.
Steroids play a part too
Steroids used for graft-versus-host disease (GVHD, where the donor cells attack your own tissues) can raise blood sugar, add weight around the middle and reduce your body's own cortisol, a stress hormone made by the adrenal glands.
The reassuring part
Most hormone problems after a transplant can be treated, usually by replacing the missing hormone. That is why regular checks matter so much. Finding a low thyroid early is simple. Living with it untreated for years is not.
Children who had a transplant need their growth and puberty followed closely until they are fully grown.What can be affected
Which glands are most often affected, and how would you notice?
Not everyone develops these. Your risk depends on the treatment you had, your age at the time and how long steroids were needed.
Thyroid
An underactive thyroid is one of the most common late effects, especially after radiation. It slows the body down.
Signs you may notice
- Tiredness and feeling cold
- Weight gain and constipation
- Dry skin and low mood
Ovaries
Many women stop having periods after a transplant, and this may be early menopause. It can affect bones, heart health, mood and fertility, so it needs assessment rather than waiting.
Testes
Sperm production is often reduced. Testosterone may also fall, causing low energy, low sex drive and loss of muscle. Men can have normal testosterone and still have low fertility.
Adrenal glands and blood sugar
Long courses of steroids can quieten the adrenal glands and raise blood sugar. Some people develop diabetes or high cholesterol after a transplant and need regular checks for both.
Growth in children
Radiation and some chemotherapy can slow growth and delay or bring forward puberty. A children's hormone specialist usually follows this with height checks and blood tests.
Not sure whether this applies to you?
Ask an oncologistOn your report
What do the hormone tests on your report mean?
- TSH
- A signal from the brain telling the thyroid to work. A high TSH usually means the thyroid is underactive.
- Free T4
- The main hormone the thyroid makes. It is read alongside TSH, not on its own.
- FSH and LH
- Signals that drive the ovaries and testes. High levels often mean those glands are not responding well.
- Oestradiol and testosterone
- The main sex hormones. Low levels can explain missed periods, low energy or low sex drive.
- AMH
- A rough guide to how many eggs remain in the ovaries. It helps fertility planning but cannot predict a pregnancy.
- HbA1c
- Your average blood sugar over recent months, used to check for diabetes.
Reference ranges differ between laboratories, and one result is always read with your symptoms and repeat tests.
Follow-up
When are hormones usually checked after a transplant?
Schedules differ between transplant centres. This is a typical pattern, not a rule.
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Before the transplant
Fertility is discussed, and where time allows, eggs, embryos or sperm may be stored. Ask about this before treatment starts, because the chance may not come again.
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The early months
Blood sugar is watched closely while you are on steroids. Your team also keeps an eye on weight and blood pressure.
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Around the end of the first year
Many centres check thyroid function, sex hormones and bone health as part of a first-year review. Periods, sex drive and energy are asked about.
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Every year after that
Thyroid tests, blood sugar and cholesterol are usually repeated once a year for life, because late effects can appear many years on.
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For children, until adulthood
Height, weight and puberty are tracked at each visit, with referral to a children's hormone specialist if growth slows.
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One thing that cannot wait
If you are on steroids, or stopped them recently, and you develop severe vomiting, confusion, extreme weakness, severe stomach pain or you collapse, go to the nearest emergency department or call 108. This can be an adrenal crisis, where the body lacks cortisol, and it needs treatment the same day. Tell the emergency team about your transplant and your steroids. Never stop or reduce steroids on your own; your treating team sets any change.
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Commonly believed
What do families often get wrong about hormone problems?
"Her periods stopped because she is weak. They will come back on their own."
Sometimes they do, but often the ovaries have been affected. Early menopause left untreated can thin the bones and affect the heart. It deserves a proper assessment, not waiting.
"Once you start thyroid tablets, the dose never changes."
Thyroid replacement needs regular blood tests, and the doctor may adjust the dose over time. Keep taking it exactly as prescribed and keep every follow-up test.
"After a transplant, having children is impossible."
Fertility is often reduced, but not always lost, and stored eggs, embryos or sperm can help. Some people also conceive naturally. A fertility specialist can tell you what your own tests show.
"Hormone replacement will make the blood cancer come back."
For most blood cancers, replacing a missing hormone is not linked to the cancer returning. The decision still belongs to your haematologist and hormone specialist together, who weigh your own history.
Being straight with you
What can this page not tell you?
This page cannot tell you whether you will develop a hormone problem, or which one. That depends on the conditioning treatment you had, whether radiation was used, your age at transplant and how long you needed steroids.
What to bring to your next review
Bring your discharge summary, which names your conditioning treatment, and every blood report since. Write down changes in energy, weight, periods, sex drive and mood, even ones that feel minor or awkward to raise.
Questions worth asking
Which hormone tests do I need, and how often? Should I see an endocrinologist, a doctor who specialises in hormones? Is my fertility affected, and can it be tested? For a woman, is this early menopause, and what protects my bones and heart?
How CION can help
CION's haematology team reviews your reports, presents your case at a tumour board and coordinates long-term follow-up with your transplant centre and hormone or fertility specialists where you need them.
Questions we are asked
Common questions about hormones after a transplant
How long after a transplant can thyroid problems start?
They can appear within the first year, but many show up years later, especially after radiation. That is why thyroid blood tests are usually repeated once a year for life, even if you feel well. Mention tiredness, weight gain or feeling cold between tests rather than waiting for the next check.
My periods stopped after the transplant. Is this menopause?
It may be. Blood tests for FSH and oestradiol, read with your age and symptoms, help your doctor decide. It is not something to simply wait out, because early menopause affects bones, heart and mood. Ask whether hormone replacement suits you, and who should prescribe it.
Can I still become a parent after a transplant?
Possibly. Many people have reduced fertility, but it is not always lost. Stored eggs, embryos or sperm can be used, and some people conceive naturally. A fertility specialist can test what remains. If a pregnancy is possible, ask your team about safe contraception until you are ready.
Why has my blood sugar gone up?
Steroids are the most common reason. Weight gain, less activity and some other transplant medicines can add to it. Sometimes it settles as steroids are reduced, and sometimes diabetes remains. Your team will check HbA1c and decide on treatment. Do not change any medicine on your own.
Is it safe to take thyroid tablets with my other medicines?
Usually yes, but timing matters. Some medicines, calcium and iron can reduce how well thyroid tablets are absorbed. Your doctor or pharmacist will tell you how to space them. Keep a written list of every medicine you take and show it at each visit.
My son had a transplant as a child. Is his growth affected?
It can be, especially if radiation was used. His height and puberty should be checked at every follow-up visit until he is fully grown. If growth is slowing, a children's hormone specialist can test for growth hormone and discuss whether treatment would help.
Do I need a hormone specialist, or can my haematologist manage this?
Your haematologist usually arranges the routine tests. If a problem is found, or fertility, growth or menopause are involved, an endocrinologist often joins your care. The two work together, because some hormone treatments need to fit around your transplant medicines and follow-up.
Can hormone problems explain feeling low or anxious?
Yes, partly. A low thyroid, low testosterone or early menopause can all affect mood, sleep and energy. So can the strain of the transplant itself. Ask for hormone tests, and also ask for emotional support. Treating one does not always fix the other.
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Dr. Basudev Pokhrel reviews blood counts, transfusion needs and blood disorders, and works with the CION tumour board on blood cancers.
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Sources
- National Cancer Institute — Late Effects of Cancer Treatment
- NHS — Underactive thyroid (hypothyroidism)
- NHS — Early menopause
- NHS — Stem cell and bone marrow transplants
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Long-Term Follow-Up Schedule After TransplantWhere hormone checks fit in your yearly reviewsBone Health After TransplantLow hormones and steroids both thin the bonesExercise and Rebuilding Strength After TransplantHelps weight, blood sugar and energyLife After TransplantEvery guide on recovery after a transplant
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