睾丸癌(TC)治疗使许多患者的睾丸激素水平较低。虽然大多数具有低睾酮(<-2SD)和性腺功能减退症状的TC患者会开始睾酮替代疗法(TRT),TRT在轻度Leydig细胞功能不全患者中的作用,定义为黄体生成素升高与临界低睾酮相结合,是未知的。为了澄清TRT是否能改善抑郁和焦虑的症状,性功能,疲劳,轻度Leydig细胞功能不全的TC幸存者的生活质量。
总共,69名年龄在18至65岁之间的男性,在TC治疗后患有轻度Leydig细胞功能不全,随机分为1:1至12个月,每天经皮睾酮(最大剂量40毫克/天)与安慰剂。患者报告焦虑,抑郁症,性功能,疲劳,在基线时评估总体生活质量,经过6个月和12个月的治疗,和治疗后3个月使用验证问卷。
治疗12个月后,睾酮组的中位黄体生成素和中位游离睾酮均恢复正常.与安慰剂相比,TRT与焦虑和抑郁症状的统计学显着改善无关,性功能,疲劳,和整体生活质量。睾酮替代疗法并不能改善焦虑,抑郁症,性功能,疲劳,与安慰剂相比,轻度Leydig细胞功能不全患者的整体生活质量。
一般不推荐对轻度Leydig细胞功能不全的TC幸存者进行常规TRT,以改善性功能和生活质量。研究结果应优选在更大的队列中验证。
Testicular cancer (TC) treatment leaves many patients with low levels of testosterone. While most TC patients with low testosterone (< - 2 SD) and hypogonadal symptoms will initiate testosterone replacement therapy (TRT), the role of TRT in patients with mild Leydig cell insufficiency, defined as elevated luteinizing hormone in combination with borderline low testosterone, is unknown. To clarify if TRT improves symptoms of depression and anxiety, sexual function, fatigue, and quality of life in TC survivors with mild Leydig cell insufficiency.
In total, 69 men aged between 18 and 65 years with mild Leydig cell insufficiency after TC treatment were randomized 1:1 to 12 months daily transdermal testosterone (maximum dose 40 mg/daily) vs. placebo. Patient reported anxiety, depression, sexual function, fatigue, and overall quality of life were assessed at baseline, after 6- and 12 months treatment, and 3 months post-treatment using validated questionnaires.
After 12 months of treatment, median luteinizing hormone and median free testosterone were normalized in the testosterone group. Compared to placebo, TRT was not associated with statistically significant improvement of symptoms of anxiety and depression, sexual function, fatigue, and overall quality of life. Testosterone replacement therapy did not improve anxiety, depression, sexual function, fatigue, or overall quality of life in patients with mild Leydig cell insufficiency compared to placebo.
Routine TRT in TC survivors with mild Leydig cell insufficiency to improve sexual function and quality of life cannot be generally recommended. The findings should preferably be validated in a larger cohort.