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Male cancer survivors with low testosterone levels experience reduced energy and sexual function, and thus might benefit from hormone replacement therapy, a new study found.

Young male cancer survivors reported marked reductions of energy levels, quality of sexual functioning, and overall quality of life, particularly if they had serum testosterone deficiency (≤10 nmol/L) as a result of radiotherapy or chemotherapy, according to an online report Feb. 22 in Cancer.

However, they appeared to cope with these issues: the men did not appear to suffer from greater psychological distress, low self-esteem, or impaired sexual relationships.

"Impaired quality of life, fatigue, and sexual function are common in young male cancer survivors and worse in those with hypogonadism," Richard J.M. Ross, MD, of University of Sheffield, in Sheffield, England, and colleagues wrote. "Future studies are now required to determine to what extent quality of life, fatigue, and sexual function can be improved by testosterone replacement."

Previous research has shown that male cancer survivors suffer fatigue, poor quality of life, sexual dysfunction, and hypogonadism (low testosterone), but the relationship between hypogonadism and these other ailments was not clear.

To investigate, Ross and colleagues compared 176 cancer survivors to 213 young men without cancer. All were 25 to 45 years old.

The participants had total blood testosterone levels measured and completed three quality of life questionnaires: the Short-Form Health Survey, Aging Male Scale, and the Functional Assessment of Chronic Illness Therapy-Fatigue.

They also completed measures of self-esteem (Rosenberg Self-Esteem Scale), fatigue (Functional Assessment of Chronic Illness Therapy-Fatigue), and sexual function (Derogatis Interview for Sexual Functioning-II Self-Report-Male).

The cancer survivors in the study had been treated for cancers that were not hormone-dependent (lymphoma, 40.9%; germ cell, 38.6%; others types, such as leukemia, gastrointestinal, brain, sarcoma, and skin, 20.5%). The treatments involved cytotoxic chemotherapy (96.5%) and/or radiotherapy (40.3%), including cranial irradiation or radiotherapy fields involving the testes.

Compared to controls, the cancer survivors reported impaired quality of life in all portions of the Short-Form Health Survey and Aging Male Scale. They also reported more fatigue than controls.

Cancer survivors with lowest testosterone levels (testosterone ≤10 nmol/L) report worse quality of life and lower self-esteem, fatigue, and sexual function than those without hypogonadism (testosterone >10 nmol/L).

The quality-of-life impairment instrument most strongly associated with low testosterone was the physical component summary (PCS) of the Short-Form Health Survey (r=0.34).

The researchers found that for every one-unit increase in blood testosterone levels, the PCS score increased by 0.65 (95% CI, 0.37 to 0.92; P=0.001), suggesting that approximately 11% of the variability in PCS was explained by testosterone levels.

Although the study found that survivors with low testosterone tended to have impaired sexual function and drive, this did not seem to interfere with their relationships.

"Our results indicate no impairment in partner satisfaction of the young male cancer survivors despite their reduced sexual drive," the authors wrote.

"We suggest that possibly the quality of their relationship transcends the decrement in sexual performance these men demonstrate, and that the impact of surviving a potentially fatal illness together may be a more powerful influence on their relationship than sexuality."

The researchers noted that they found only weak associations between testosterone levels and most health measures, and that the relationship between testosterone and quality of life did not appear to be linear.

"Compared with controls, even patients with a testosterone level in the highest quartile still reported compromised quality of life for the Short-Form Health Survey," they wrote.

"We considered that there may be a nonlinear relationship or cutoff in testosterone that determined quality of life; we observed a plateau in quality of life (PCS) score for patients with testosterone >20 nmol/L and that the patients with testosterone <10 nmol/L had the worst quality of life, indicating that there may be a threshold for testosterone effect on quality of life."

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