J Cachexia Sarcopenia Muscle (2012) 3:149–155 DOI 10.1007/s13539-012-0065-7 REVIEW Hypogonadism in male cancer patients Basil O. Burney & Jose M. Garcia Received: 16 November 2011 / Accepted: 21 March 2012 / Published online: 20 April 2012 # The Author(s) 2012. This article is published with open access at Springerlink.com Abstract Prevalence of hypogonadism in men with cancer has been reported between 40% and 90%, which is significantly higher than in the general population. Hypogonadism is likely to affect the quality of life in these patients by contributing to non-specific symptoms, including decreased energy, anorex- ia, sarcopenia, weight loss, depression, insomnia, fatigue, weak- ness, and sexual dysfunction. Pathogenesis of hypogonadism in cancer patients is thought to be multi-factorial. Inflammation may play an important role, but leptin, opioids, ghrelin, and high-dose chemotherapy through different mechanisms have all been implicated as the cause. Hypogonadism is also associated with poor survival in cancer patients. Data looking into the treatment of hypogonadal male cancer patients with testosterone are limited. However, improvements in body weight, muscle strength, lean body mass, and quality of life have been shown in hypogonadal men with other chronic diseases on testosterone replacement therapy. Prospective and interventional trials are needed to test the efficacy and safety of testosterone treatment in improving quality of life of these patients. Keywords Inflammation . Leptin . Ghrelin . Cachexia . Sarcopenia 1 Introduction Approximately 800,000 men are diagnosed with cancer each year in the USA [1], and cancer treatments account B. O. Burney : J. M. Garcia (*) Division of Endocrinology, Diabetes and Metabolism, Michael E. DeBakey Veterans Affairs Medical Center, Baylor College of Medicine, 2002 Holcombe Blvd, Bldg 109, Rm 210, Houston, TX 77030, USA e-mail: jgarcia1@bcm.edu for more than $41 billion in spending each year [2]. Cancer patients suffer from significant morbidity caused by the primary disease directly or by the administration of chemo- therapy or radiotherapy. They often present with non- specific symptoms, including decreased energy, anorexia, sarcopenia, weight loss, depression, insomnia, fatigue, weakness, and sexual dysfunction. Some of these symp- toms are known to be associated with hypogonadism in patients with advanced cancer [3] and have a profound impact in these individuals’ survival, quality of life, and return to productivity. Here, we review the evidence of the potential contribution of hypogonadism to symptom burden in male patients with cancer, its pathophysiolo- gy, and the potential therapeutic role of testosterone replacement in this setting. 2 Prevalence of hypogonadism in non-cancer and cancer patients The prevalence of hypogonadism in non-cancer patients increases with age. For example, in the Baltimore Longitudi- nal Study of Aging, the incidence of hypogonadism was approximately 20% in men over 60, 30% in men over 70, and 50% in men over 80 years of age using total testosterone levels <325 ng/dl as a criterion [4]. In the Massachusetts Male Aging Study, a population-based cohort of men between ages 40 and 69 years, the estimated crude prevalence of androgen deficiency at baseline and follow-up were 6% and 12%, respectively [5]. In the Hypogonadism in Male (HIM) study which included 2,162 men older than 45 years of age in the primary care setting, the crude prevalence of hypogonadism (defined as total testosterone <300 ng/dl) was 39% [6]. Prevalence of hypogonadism in cancer patients ranges from 40% to 90% [7, 8]. In an early study, total testosterone