Sexual functioning in testosterone-supplemented patients treated for bilateral testicular cancer

Objective To determine the effects of intramuscular injections with testosterone (Sustanon(R)) on sex-hormone levels, sexual functioning and general wellbeing in patients treated with orchidectomy for bilateral testicular cancer.Patients and methods The study comprised seven men (median age 38 years, range 25-46) who had undergone orchidectomy for bilateral testicular cancer. Patients received intramuscular injections with testosterone every 3 weeks and blood samples for hormone analysis were collected from each patient at three times; one day after testosterone injection (t(1)), halfway between subsequent injections (t(2)) and just before injection (t(3)). Plasma hormone levels were then related to sexual function, as assessed by self-reported data on sexuality and general well-being, measurements of nocturnal penile tumescence and rigidity (NPTR) and erectile function elicited by visual erotic stimulation (VES), determined at t(1), t(2) and t(3).Results During the 3-week interval between injections, there was a sixfold decrease in plasma testosterone level (mean testosterone 35.8, so 7.8, and 6.0, so 2.5 nmol/L, at t(1) and t(3), respectively). At t(1), five of the men had a plasma testosterone level above the upper normal limit (>35 nmol/L) and at t(2) and t(3), testosterone levels were below the reference range (Conclusion In most patients castrated for bilateral testicular cancer and receiving intramuscular injections with testosterone, plasma testosterone levels were outside the normal range. After injection, there was a rapid decline of plasma testosterone to levels below the lower normal limit. With the exception of oestradiol, sex-hormone levels were not correlated to testosterone levels. Sexual functioning was not affected by the fluctuations of plasma testosterone level. However, at the end of the injection interval, adverse psychological and physical effects had a significant impact on libido and arousal.