Leydig cell function in male survivors of childhood cancer: A report from the St Jude lifetime cohort study

Abstract

This retrospective study, with cross-sectional health outcomes analysis, evaluated Leydig cell function in 1516 childhood cancer survivors at a median duration of 22.0 years after cancer diagnosis. These patients are part of the St Jude Lifetime Cohort. An age- and sex-matched community control group was recruited among friends and relatives of patients. Leydig cell failure (LCF) was defined as serum total testosterone <250 ng/dl and LH >9.85 IU/l, while Leydig cell dysfunction (LCD) was defined as testosterone ≥250 ng/dl and LH >9.85 IU/l. Follow-up data were available on 683 participants (45.2%). The point prevalence of LCF and LCD at the most recent evaluation was 6.9% and 14.7%, respectively; 42/104 patients with LCF (40.4%) used hormone replacement therapy. Eight controls, (4.8%) were receiving testosterone, but the indications for treatment were not available. No control had LCF, while 4 individuals had LCD. Independent risk factors for LCF included: age ≥26 years at assessment, testicular radiotherapy, and alkylating agents at cyclophosphamide equivalent doses ≥4000 mg/m2. LCF was also associated with: abdominal obesity, diabetes mellitus, erectile dysfunction (ED), muscle weakness, and all-cause mortality. Hormone-treated LCF was associated with increased waist circumference, ED, muscle weakness, and depression, but not with all-cause mortality. LCD was associated with unilateral orchiectomy and the same risk factors as LCF. No significant associations of LCF and LCD with adverse physical or psychosocial outcomes were found.