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Sexual function with and without erythropoietin therapy

The treatment of anemia in dialysis patients with recombinant human erythropoietin (rhEpo) has allowed to obtain many clinical benefits (1). Among these the improvement of sexual function is very important for life quality (2). It has been reported that this is in part due to the correction of endocrine sexual abnormalities (3, 4). The aim of the present study has been not only to verify these observations, but also to evaluate if there are differences in sexual function and hormones according to the natural rather than to the pharmacological origin of an equivalent mild level of anemia. For this purpose two groups of male hemodialysis patients with different haemoglobin concentrations, but similar in age and dialysis treatment time, have been studied. Patients of the first group, who were affected by severe anemia (group A), received rhEpo at the initial dose of 50 U/kg i.v. three times week. The dose has then been adjusted in order to keep a mean hemoglobin concentration similar to the one of the second group, who had a mild level of anemia (group B). Evaluation of sexual function through a questionnaire with items concerning libido, capacity and performance, and assessment of the endocrine reproductive system status were performed in all subjects. In group A both investigations were repeated after one year of rhEpo therapy. Before rhEpo treatment sexual function showed to be nearly absent in 30%, markedly reduced in 25% and "normal" in 17% of group A patients. After rhEpo therapy all but one patients reported, to various extents, an improvement of sexual function, which was present in all subjects, though markedly reduced in the same percentage as before. Approximately the same situation was observed in group B patients, all of whom stated to have a sexual activity which was "normal" in 20% and markedly reduced in 30% of cases. Unlike other investigations (4, 5) it has not been possible to confirm after rhEpo an increase in total and free testosterone (TT, FT) whose pre-treatment values were already in the normal range. However, group B TT level was significantly higher than group A pre(p<0.01) and post-treatment (p>0.001) values. For FT, which showed the same trend, significant differences could not be calculated. Progesterone (Prog) mean value did not change in the two groups and after treatment, being always normal. No significant differences were found either for estradiol (17BE), even if with severe anemia its mean value was clearly above the upper normal limit. According to a previous report and in opposition to others (3, 4, 6), this study has not demonstrated after rhEpo therapy significant variations of gonadotropins (FSH, LH) and prolactin (PRL) concentrations, which still remained higher than normal. It is likely that the great individual variability may have played a role in determining this result. On the other hand it is perhaps worthwhile to point out that in group B mean FSH and LH values were in the normal range and that mean PRL concentration was considerably lower than after rhEpo. These observations, though not statistically significant, parallel the already mentioned result for TT. In conclusion, in male hemodialysis patients the treatment of severe anemia by rhEpo certainly permits to improve sexual function. No difference apparently exists between rhEpo treated subjects and a control group with mild anemia. Sexual hormones, part of which were already normal before treatment, did not show significant variations after rhEpo therapy. In