SEXUAL FUNCTIONING IN TESTOSTERONE-SUPPLEMENTED PATIENTS TREATED FOR BILATERAL TESTICULAR CANCER

Objective To determine the effects of intramuscular injections with te stosterone (Sustanon(R)) on sex-hormone levels, sexual functioning and general wellbeing in patients treated with orchidectomy for bilateral testicular cancer. Patients and methods The study comprised seven men (median age 38 years, range 25-46) who had undergone orchidectomy for bilateral testicular cancer. Patients received intramuscular injectio ns with testosterone every 3 weeks and blood samples for hormone analy sis were collected from each patient at three times; one day after tes tosterone injection (t(1)), halfway between subsequent injections (t(2 )) and just before injection (t(3)). Plasma hormone levels were then r elated to sexual function, as assessed by self-reported data on sexual ity and general well-being, measurements of nocturnal penile tumescenc e and rigidity (NPTR) and erectile function elicited by visual erotic stimulation (VES), determined at t(1), t(2) and t(3). Results During t he 3-week interval between injections, there was a sixfold decrease in plasma testosterone level (mean testosterone 35.8, so 7.8, and 6.0, s o 2.5 nmol/L, at t(1) and t(3), respectively). At t(1), five of the me n had a plasma testosterone level above the upper normal limit (>35 nm ol/L) and at t(2) and t(3), testosterone levels were below the referen ce range (<10 nmol/L) in three and six men, respectively. Oestradiol ( E(2)) levels showed the same pattern: at t(1) the mean (SD) E(2) level was 0.17 (0.07) nmol/L and at t(3) 0.07 (0.01) nmol/L. In contrast to follicle-stimulating hormone, luteinizing hormone (LH) mirrored the d ecline in plasma testosterone after injection, with the lowest levels at t(1) and the highest at t(3). Other hormone levels remained unchang ed. Three patients reported loss of libido, decreased arousal, erectil e dysfunction, fatigue and mood depression. However, neither the arous al nor the erectile problems could be verified by VES. There was no re lationship between plasma testosterone levels, the reported sexual dys functions and the results of NPTR and VES measurements. Although unrel ated to a specific testosterone level, three patients reported increas ed irritability, excessive sweating, hot flushes and heat intolerance at the end of the injection interval. These adverse effects of declini ng plasma testosterone were related to loss of libido and other sexual problems. Conclusion In most patients castrated for bilateral testicu lar cancer and receiving intramuscular injections with testosterone, p lasma testosterone levels were outside the normal range. After injecti on, there was a rapid decline of plasma testosterone to levels below t he lower normal limit. With the exception of oestradiol, sex-hormone l evels were not correlated to testosterone levels. Sexual functioning w as not affected by the fluctuations of plasma testosterone level. Howe ver, at the end of the injection interval, adverse psychological and p hysical effects had a significant impact on libido and arousal.