Lower levels of serum testosterone, quality of life, and treatment for testicular cancer: a prospective cohort study (#324)
Testicular cancer survivors typically have serum testosterone in the lower spectrum of the normal range, with 13-25% hypogonadal by laboratory criteria according to the literature. They are also at increased risk of poorer quality of life, which is typically attributed to psychological and physical effects of diagnosis and treatment, but to which low levels of serum testosterone could also contribute.
Our aim is to describe serum concentrations of testosterone, related sex hormones, and their associations with self-rated symptoms and wellbeing after treatment for testicular cancer. We hypothesised that patients with serum testosterone in the lower spectrum of the normal range would be more likely to report fatigue, depression and poor functional wellbeing.
We recruited 100 patients with testicular cancer within 2 months of initial surgery to a prospective cohort study. Patients were tested for serum levels of sex hormones (testosterone, FSH, LH) and completed quality of life [QoL] questionnaires (Hospital Anxiety and Depression Scale [HADS], Functional Assessment of Chronic Illness Therapy – Fatigue [FACIT-F]). We studied the association of pre-specified categories of testosterone levels with QoL scores at 12 months from treatment using general linear models.
54 patients had evaluable data. 15 underwent surgery +/- radiotherapy, and 39 chemotherapy+/- surgery. 2 received testosterone replacement. At 12 months, hormone assays revealed biochemical hypogonadism (testosteroneULN) in 33%, low-normal testosterone (LLN≤testosterone<12nmol/L) in 24%, and high-normal testosterone in 43%. Impairment was reported for anxiety and depression in 19% and 6% respectively. Median scores on all FACIT-F subscales were close to normal. We found no association between testosterone levels and QoL (all P>0.05).
A higher than expected proportion of patients had biochemical hypogonadism at 12 months following treatment. Most patients had normal quality of life. Screening should be encouraged for hypogonadism. Hypogonadal patients should be considered for testosterone replacement because they are at increased risk of metabolic syndrome, cardiovascular disease, impaired fertility and osteoporosis.