1. Young male cancer survivors with low-normal serum morning total testosterone benefited from testosterone treatment as a therapeutic option to improve body composition.
Evidence Rating: 1 (Excellent)
Endocrine dysfunction as a long-term sequelae of cancer and its treatments affect are highly prevalent, affecting up to 50% of adult childhood cancer survivors. Impairment of the hypothalamic-pituitary-gonadal axis is one of particular concern, as evidence of impaired gonadal function is present in over 50% of male cancer survivors, manifesting as increased trunk mass, and worsened quality of life (QoL) in the 27% of young male cancer survivors aged 25-45 years that are below the 10th percentile of serum testosterone levels compared to matched controls. Previous research involving testosterone therapy tended to focus on older men over the age of 65, and the suitability of testosterone replacement as a therapeutic option to improve body composition and quality of life in childhood malignancy survivors had yet to be investigated. In this study, a total of 136 male survivors of testicular cancer, lymphoma, and leukemia aged 25-50 years (42.6% aged 25-37 years, 57.4% 38-50 years, 88% testicular cancer, 10% lymphoma, matched for body mass BMI) years with a morning total serum testosterone of 7-12nmol/l were randomized 1:1 between July 2012 and February 2015 to either receive testosterone (Tostran 2% gel) or placebo for 26 weeks. The coprimary end points were trunk fat mass and SF36 Physical Functioning score (SF36-PF) as a measure of QoL at 26 weeks by intention to treat. Compared to placebo, the treatment group receiving testosterone had significantly decreased trunk fat mass (-0.9kg, 95% CI -1.6 to -0.3, p = 0.0073), decreased whole-body fat mass (-1.8kg, 95% CI -2.9 to -0.7, p = 0.0016), and increased lean body mass (1.5kg, 95% CI 0.9-2.1, p < 0.001). There was no associated change in QoL or metabolic profile, and the treatment was generally well tolerated. Study findings demonstrate that testosterone replacement improves body composition in young male cancer survivors, and may be considered in the context of other interventions to reduce trunk mass and increase muscle mass.
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