BACKGROUND:Testosterone replacement in hypogonadal males improves body composition, sexual function, and health-related quality of life. Male cancer survivors are at risk of androgen deficiency; however, when and in whom testosterone should be replaced remain unanswered questions. OBJECTIVE:The aim of our study was to define the prevalence of androgen deficiency in this patient group through assessment of testosterone levels and related measures. DESIGN:This was a cross-sectional, observational study of cases and controls. We recruited 176 cancer survivors and 213 controls, aged 25-45 yr. RESULTS:Of cancer survivors, 97% had received chemotherapy and 40% radiotherapy. Cancer survivors had lower total testosterone (tT) levels than controls (mean difference 2.67 nmol/liter; 95% confidence interval 1.58-3.76; P = 0.003), and 24 of 176 (13.6%; 95% confidence interval 9.3-19.5) had a tT less than 10 nmol/liter, which was less than 2.5% centile for controls. Cancer survivors had a greater fat mass, higher fasting insulin and glucose levels, increased fatigue, and reduced sexual function and health-related quality of life. In both cohorts, the tT correlated negatively with insulin levels and negatively with body fat mass; however, the difference in tT between them was independent of fat mass. We measured tT and SHBG and calculated bioavailable testosterone. The changes in calculated bioavailable testosterone were similar to tT. CONCLUSIONS:A significant proportion of young male cancer survivors had a frankly low tT associated with an increased fat mass and insulin level compared with controls. These factors would be predicted to improve in response to testosterone replacement therapy and provide a powerful argument for an interventional study of testosterone therapy in young male cancer survivors.

译文

背景:性腺功能减退男性中的睾丸激素替代可改善身体组成,性功能以及与健康相关的生活质量。男性癌症幸存者有雄激素缺乏症的风险;然而,何时何地应更换睾丸激素仍未解决。
目的:我们的研究目的是通过评估睾丸激素水平和相关措施来确定该患者组中雄激素缺乏症的患病率。
设计:这是对病例和对照的横断面观察性研究。我们招募了176位年龄在25-45岁之间的癌症幸存者和213位对照。
结果:在癌症幸存者中,有97%接受了化疗,而40%接受了放疗。癌症幸存者的总睾丸激素(tT)水平低于对照组(平均差异2.67 nmol /升; 95%置信区间1.58-3.76; P = 0.003),176人中有24人(13.6%; 95%置信区间9.3-19.5) tT小于10 nmol /升,对于对照而言,小于2.5%百分位。癌症幸存者的脂肪量更大,空腹胰岛素和葡萄糖水平更高,疲劳加剧,性功能下降以及与健康相关的生活质量下降。在这两个队列中,tT与胰岛素水平呈负相关,与体脂质量呈负相关。但是,它们之间的tT差异与脂肪量无关。我们测量了tT和SHBG,并计算了生物利用睾丸激素。计算的生物利用睾丸激素的变化与tT相似。
结论:与对照组相比,相当大比例的年轻男性男性癌症幸存者的tT明显较低,与脂肪量和胰岛素水平增加有关。这些因素预计将对睾丸激素替代疗法的反应有所改善,并为年轻男性癌症幸存者进行睾丸激素疗法的干预研究提供有力论据。

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