Homosexual men taking bicalutamide for prostate cancer were much more likely to report sexual problems during treatment than heterosexual patients, according to a study in the July issue of the urology journal BJUI. Researchers from Romania and the USA studied 17 heterosexual men and 12 homosexual men receiving a 50mg daily dose of bicalutamide, a fast-acting, non-steroidal anti-androgen, which is similar to other anti-androgens, but with reportedly fewer side effects.
They discovered that homosexual men reported that their sexual performance and satisfaction more than halved in four of the six categories studied. Heterosexual men, on the other hand, reported fewer problems and were considerably more satisfied with intercourse.
The patients were asked to compare their sexual functioning - erectile function, orgasmic function, sexual desire and overall functioning – before treatment started and five weeks after it commenced.
"Anti-androgens are given to men with prostate cancer to stop the male hormones stimulating the growth of the cancer cells" explains Dr Ion G Motofei from Carol Davila University, Romania. "The aim of this study was to see whether this hormone treatment affected heterosexual and homosexual men in different ways and our results clearly show that it does.
"The homosexual patients in our study reported significant reductions in all aspects of their sexual functioning and satisfaction, ranging from 23 per cent to 54 per cent.
"However, the heterosexual group only reported slight reductions in two of the six categories, ranging from one per cent to four per cent. They also reported no change in one category and improvements in the remaining three, including a 45 per cent increase in intercourse satisfaction."
The 28 men had an average age of 61, with no significant difference between the heterosexual and homosexual patient groups. Each completed the International Index of Erectile Function questionnaire. The detailed results showed that:
Overall sexual function: heterosexual men averaged 54.3 out of 75 before treatment, rising slightly to 56.1 during treatment. However the scores for the homosexual patients fell by 46 per cent from 52.9 to 28.7.
Erectile function: before treatment the groups averaged 25.1 and 24.5 out of 30. During treatment, the heterosexual group fell slightly to 24.1, while the homosexual group fell by 51 per cent to 12.1.
Orgasmic function: both groups were similar, averaging 7.1 and 7.2 out of 10 before treatment. The heterosexual group remained at 7.1, but the homosexual group fell by 54 per cent to 3.3 during treatment.
Sexual desire: before treatment the groups averaged 6.5 and 7.6 out of 10. The heterosexual group increased to 7.5 during treatment, but the homosexual group fell by 51 per cent to 3.7.
Intercourse satisfaction: the groups averaged 7.1 and 8.0 out of 15 before treatment. During treatment, the heterosexual group increased by 45 per cent to 10.3, while the homosexual group fell by 23 per cent to 6.2.
Overall satisfaction: the groups started with similar scores of 7.2 and 7.1 out of 10 before treatment. But while the heterosexual group fell very slightly to 7.1, the homosexual group fell by 52 per cent to 3.4.
"The results of our study suggest that androgens play a role in cerebral sexual processes such as libido, sexual arousal and orgasm and that this response may be different in heterosexual and homosexual men" says co-author Dr David L Rowland from Valparaiso University, Indiana, USA.
"However, it is important that we do not underestimate the effect that androgens can have on heterosexual men just because the effect on homosexual men appears to be greater."