Patterns of Leydig cell insufficiency in adult males following bone marrowtransplantation for haematological malignancies

Gonadal and sexual function are key to quality of life following bone marro w transplantation (BMT), but no large studies have been published on Leydig cell (LQ function in adults. LC insufficiency (LCI) can cause premature an dropause with its consequences including sexual morbidity from diminished l ibido and erectile dysfunction (ED). In addition, LCI can result in general ised fatigue and even osteopenia. We reviewed gonadal function pre-transpla nt (immediately prior to BMT) and at 3-18 months post BMT in 117 patients w ho underwent BMT for a variety of haematological malignancies. The patients presented with variable degrees of symptoms of LCI, such as fatigue, dimin ished sex drive and libido or ED. The results suggest that the patients sus tained severe gonadal damage to both their germ cells (GC) as well as the L C compartment (P < 0.001). We characterised two distinct functional subsets of LC insufficiency: Type I: compensated type with high LH and normal T le vels and low T/LH ratio: (n = 102); and type II: uncompensated type (premat ure andropause) with high LH and low testosterone levels with low T/LH rati o (n = 15). Although type II patients had more severe LC damage than type I , patients in both groups were symptomatic. We recommend that symptomatic p atients in both groups may benefit from a therapeutic trial with testostero ne replacement treatment (TRT) for 3-6 months.