title: Low testosterone levels and increased inflammatory markers in patients with cancer and relationship with cachexia.
abstract: BACKGROUND
  Male cancer patients suffer from fatigue, sexual dysfunction, and decreased functional performance and muscle mass. These symptoms are seen in men with hypogonadism and/or inflammatory conditions. However, the relative contribution of testosterone and inflammation to symptom burden in cancer has not been well-established.
  
  
  OBJECTIVE
  The aim of this study was to measure testosterone levels in male cancer patients and determine the relationship between testosterone, inflammation, and symptom burden.
  
  
  METHODS
  This cross-sectional study enrolled patients from a tertiary-care center. SUBJECTS/OUTCOME MEASURES: Subjects included males with cancer-cachexia (CC; n = 45) and cancer without cachexia (CNC; n = 50), as well as noncancer controls (CO; n = 45). Total testosterone (TT), bioavailable testosterone, C-reactive protein (CRP), and IL-6 were measured in plasma. Functional performance was assessed by the ECOG (Eastern Cooperative Oncology Group) and KPS (Karnofsky Performance Scales), and sexual function was assessed by the IIEF (International Index of Erectile Function).
  
  
  RESULTS
  Low testosterone levels were seen in more than 70% of CC cases. TT was lower in CC compared to CNC (P < 0.05). Also, CC had lower bioavailable testosterone, grip strength, IIEF scores, appendicular lean body mass, and fat mass and higher IL-6 and CRP compared to controls (P ≤ 0.05). ECOG and KPS were lower in CC and CNC compared to controls (P ≤ 0.05). On multiple regression analysis, TT, albumin, and CRP predicted symptoms differentially in cancer patients.
  
  
  CONCLUSIONS
  CC patients have higher inflammation and lower testosterone, grip strength, functional status, erectile function, fat mass, and appendicular lean body mass. Inflammation, TT, and albumin are associated with heavier symptom burden in this population. Interventional trials are needed to determine whether testosterone replacement and/or antiinflammatory agents benefit cancer patients.
authors.affiliation: Division of Endocrinology, Diabetes, and Metabolism, Michael E. DeBakey Veterans Affairs Medical Center, Baylor College of Medicine, 2002 Holcombe Boulevard, Houston, Texas 77030, USA.
authors.forename: Basil O
authors.initials: BO
authors.lastname: Burney
authors.forename: Teresa G
authors.initials: TG
authors.lastname: Hayes
authors.forename: Joanna
authors.initials: J
authors.lastname: Smiechowska
authors.forename: Gina
authors.initials: G
authors.lastname: Cardwell
authors.forename: Victor
authors.initials: V
authors.lastname: Papusha
authors.forename: Peeyush
authors.initials: P
authors.lastname: Bhargava
authors.forename: Bhavana
authors.initials: B
authors.lastname: Konda
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Auchus
authors.forename: Jose M
authors.initials: JM
authors.lastname: Garcia
mesh_terms: D050154:Adiposity / Q000502:physiology; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D002100:Cachexia / Q000097:blood* / Q000150:complications / Q000503:physiopathology; D003430:Cross-Sectional Studies; D005221:Fatigue / Q000097:blood / Q000150:complications / Q000503:physiopathology; D018737:Hand Strength / Q000502:physiology; D006801:Humans; D007249:Inflammation / Q000097:blood* / Q000150:complications / Q000503:physiopathology; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D053580:Muscle Strength / Q000502:physiology; D009369:Neoplasms / Q000097:blood* / Q000150:complications / Q000503:physiopathology; D012735:Sexual Dysfunction, Physiological / Q000097:blood / Q000150:complications / Q000503:physiopathology; D013739:Testosterone / Q000097:blood*
chemical_list: D015415:Biomarkers; D015850:Interleukin-6; D013739:Testosterone; D002097:C-Reactive Protein