Fatigue, sexual function and mood following treatment for haematological malignancy: the impact of mild Leydig cell dysfunction

Fatigue, sexual dysfunction, anxiety and depression are ail more common in patients who have previously been treated with cytotoxic chemotherapy and r adiotherapy (XRT) for haematological malignancies, Following therapy, a sig nificant proportion of men have biochemical evidence of Leydig cell dysfunc tion, defined by a raised luteinizing hormone level in the presence of a lo w/normal testosterone level. We postulated that mild testosterone deficienc y may account for some of the long-term side-effects of treatment, and we h ave therefore assessed fatigue, mood and sexual function by questionnaire i n 36 patients with Leydig cell dysfunction (group 1), and also in a group o f 30 patients (group 2) with normal hormone levels who underwent the same t reatment for cancer. There was no significant difference in anxiety and dep ression scores between the two groups although anxiety scores were higher t han those previously reported for normal men, Eighty seven per cent of grou p 2 were sexually active compared with only 69% of group 1 (P = 0.1), and p atients in group 1 engaged less in sexual activity than those in group 2 (m ean of 1.8 limes per week compared with 3.2 times per week; P = 0.02) Fatig ue scores were significantly higher in both groups compared with normal men , but there were no significant differences in any of the fatigue subscales between the two groups. We conclude that mild Leydig cell insufficiency fo llowing treatment with cytotoxic chemotherapy +/- XRT is not associated wit h higher levels of fatigue and anxiety but may result in reduced sexual fun ction. These results do not provide a convincing argument that androgen rep lacement therapy is mandatory to improve quality of life in the majority of these patients, although ii may be beneficial in a minority. To establish criteria for selection of patients for a trial of androgen therapy a random ized placebo-controlled study will be necessary. (C) 2000 Cancer Research C ampaign.