Erythropoietin and sexual dysfunction

BACKGROUND: Erythropoietin (rHuEpo) therapy has been shown to improvesexual function in the male dialysis population, with several studiessuggesting a direct effect upon endocrine function, as well as correctionof anaemia. Nevertheless many male dialysis patients receiving rHuEpocontinue to complain of sexual dysfunction. METHODS: At a dedicated renalimpotence clinic, 65 male dialysis patients were screened for endocrinedisturbances. Baseline serum sex hormones were compared between thosereceiving and not receiving rHuEpo, using either the two-sample t test orthe Mann-Whitney U test, after assessing for normality. Results from fourpatients were excluded on account of either medications (antiemeticphenothiazines), hepatic dysfunction, or carcinomatosis. RESULTS:Twenty-five patients (41.0%) were receiving rHuEpo, the recipients andnon-recipients being well matched for haemoglobin (10.19 +/- 0.29 vs 10.55+/- 0.25 g/dl, n.s.), age (51.1 +/- 1.9 vs 53.6 +/- 2.1 years, n.s.) andduration of sexual dysfunction (median, 3.0 vs 3.0 years, n.s.). The rHuEporecipients had a higher median creatinine (1090 vs 972 micromol/l, P <0.02), but similar nutritional status to the non-recipients (albumin 41.0vs 39.0 g/l, n.s.). The total duration of rHuEpo therapy was 0.85 +/- 0.14years. Prolactin levels were similar in both the rHuEpo recipients and non-recipients (440 vs 541 mu/l, n.s.), as were LH (11.0 vs 10.5 iu/l, n.s.)and FSH (8.0 vs 6.5 iu/l, n.s.). However, there were significant elevationsof testosterone (19.8 +/- 1.3 vs 16.1 +/- 1.1 nmol/l, P < 0.05) and sexhormone binding globulin (SHBG) (40.5 vs 26.0 nmol/l, P < 0.01), with atrend toward elevated oestradiol (304 vs 248 pmol/l, P = 0.095) in therHuEpo-treated group. Forty-eight subjects (78.7%) received peritonealdialysis (PD), with the 19 rHuEpo recipients (39.6%) demonstratingincreased serum testosterone (21.0 +/- 1.5 vs 16.6 +/- 1.3 nmol/l, P <0.05), SHBG (40.5 vs 26.5 nmol/l, P < 0.01), LH (15.0 vs 10.0 iu/l, P< 0.01) and FSH (12.0 vs 5.3 iu/l, P < 0.05). These differences werenot demonstrated in the 13 haemodialysis (HD) subjects. CONCLUSIONS: Maledialysis patients complaining of sexual dysfunction after correction ofanaemia with rHuEpo are characterized by higher levels of serumtestosterone and SHBG, but not suppression of hyperprolactinaemia orhyperoestrogenism. Male PD subjects receiving rHuEpo also demonstratedincreased LH and FSH.