Preliminary study with bicalutamide in heterosexual and homosexual patients with prostate cancer: a possible implication of androgens in male homosexual arousal

• Published in: BJU international 2011-07, Vol.108 (1), p.110-115
• Main Authors: Motofei, Ion G., Rowland, David L., Popa, Florian, Kreienkamp, Drew, Paunica, Stana
• Format: Article
• Language: English
• Subjects: Aged; Androgen Antagonists - adverse effects; Androgen Antagonists - therapeutic use; androgens; Androgens - physiology; Anilides - adverse effects; Anilides - therapeutic use; bicalutamide; Biological and medical sciences; duality; Epidemiologic Methods; estrogens; Gynecology. Andrology. Obstetrics; heterosexual; Heterosexuality - physiology; homosexual; Homosexuality, Male; Humans; Libido - drug effects; Male; Male genital diseases; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; Nitriles - adverse effects; Nitriles - therapeutic use; Penile Erection - drug effects; Penile Erection - physiology; Prostatic Neoplasms - drug therapy; Prostatic Neoplasms - physiopathology; Sexual Behavior - physiology; Tosyl Compounds - adverse effects; Tosyl Compounds - therapeutic use; Tumors; Tumors of the urinary system; Urinary tract. Prostate gland
• ISSN: 1464-4096; 1464-410X
• DOI: 10.1111/j.1464-410X.2010.09764.x

Study Type – Symptom prevalence (case series) 
Level of Evidence 4 What’s known on the subject? and What does the study add? A recent published paper regarding sexual and cognitive duality presents that androgens act synergic with female sexual pheromones while estrogens would act synergic with male sexual pheromones in normal potent men. The same authors found in this study that bicalutamide disfavours sexual function predominantly in homosexual rather than heterosexual men suffering with prostate cancer. The results of this study are interpreted alone in this article, the similarities and differences with results corresponding to younger and normal potent men following to be discussed recently in a review regarding psychosexual dualism. OBJECTIVE • Not only has a precise characterization of libido and sexual arousal in men as a central neural process been lacking, but the interactive role of gonadal hormones and sexual orientation in such processes has never been investigated. We investigate the relationships among sexual hormones, sexual arousal, and sexual orientation in men by comparing the self‐reported sexual response of heterosexual and homosexual men with locally advanced prostate neoplasm, receiving the non‐steroidal anti‐androgen bicalutamide as monotherapy. PATIENTS AND METHODS • 29 Romanian men participated in this study: 17 heterosexual and 12 homosexual. Patients were undergoing treatment for prostate cancer consisting of a standard daily dose of 50 mg bicalutamide, a fast acting non‐steroidal anti‐androgen with action comparable to other anti‐androgen drugs but with reportedly fewer sexual side effects. • Patients retrospectively provided information regarding their sexual functioning measured by the IIEF prior to commencing bicalutamide treatment. • Then, about five weeks later, patients were asked to prospectively provide information regarding their current sexual functioning while undergoing bicalutamide treatment. RESULTS • Overall IIEF scores as well as the Erectile Function, Orgasmic Function, Sexual Desire, and Overall Satisfaction subscales showed group, treatment, and group by treatment effects. • The Intercourse Satisfaction subscale showed group and group by treatment effects. • On most subscales, homosexual men showed lower functioning than heterosexual men, primarily in response to treatment with bicalutamide. CONCLUSIONS • Treatment with an anti‐androgen in a clinical population of men undergoing therapy for prostate cancer af