Despite its believed that sexual function may improve after liver transplantation (LT), many patients complain about unsatisfactory sexual life. There are few longitudinal data on the endocrine changes which occur after liver transplantation.
Aim: To evaluate erectile sexual dysfunction (ESD) prevalence and factors associated with its development, especially with relation to the status of sex steroids. Patients and Methods: 54 post-LT male patients were invited to answer a five-item International Index of Erectile Function (IIEF-5) and Hamilton Depression Rating Scale (HS). ESD was defined as a IIEF-5 ≤21 points and depression as a HS≥8 points. Patients were tested for serum levels of testosterone (T), bioavailable T (bioT), androstane-3alpha,17beta-diol (3-DIOL-G) (glucuronide metabolite of dihydrotestosterone), SHBG, glucose and insulin.
Results: Main aetiologies of cirrhosis were HCV, HBV, alcohol, cryptogenic and NASH, showing a prevalence of 30, 22, 17, 11, and 11% respectively; median age was 60 (2078) years old and follow up was 6 to 168 months. 85% were on calcineurin inhibitors as immunossupressors. 49 patients answered the questionnaires: 5 patients (10.2%) had more than 21 points in IIFE-5 (normal erectile function) while 21 (42,9%) had <8 points (no depression), P<0.003. No correlation was found between age/ESD age/HS ESD/HS. An inverse correlation between age and T (P<0,02) and bioT (P<0,003), and a direct correlation between IIFE-5 and T (P<0,04), bioT (P<0,03) and 3-diol (P<0,03) were established.
Conclusions: i) A surprisingly high prevalence of ESD was found in our series, and it seems not to be related to psychological status, ii) Hypogonadism does not seem to improve after LT, perhaps because of pre-existing gonadal alterations (toxic-metabolic damage) and immunosuppressive pharmacological side effects, iii) Further studies are needed to find out other reasons for the relationship between hypogonadism and LT outcome, and to explore the possibility of post transplant androgen therapy.
Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.
Funding: This work was supported, however funding details are unavailable.
05 - 09 May 2012
European Society of Endocrinology