Improving Cancer-related Fatigue, Sexual Dysfunction and Quality of Life in Older Men With Cancer and Androgen Deficiency

Inclusion Criteria:

• Men with active solid or hematologic (blood) cancers who have received or arereceiving chemo- and/or radiation therapy. Patients who have no evidence of disease (NED) for 60 months or less, which means that they are <60 months from their lasttreatment (chemotherapy and/or radiation therapy) will be included.

• Age: 55 years and older

• Life expectancy of at least 6 months.

• Serum testosterone, measured by mass spectrometry (gold standard method), of <348ng/dl and/or free testosterone <70 pg/ml. The lower limits of the normal range fortotal testosterone in healthy men is 348 ng/dL and the lower limits of freetestosterone is <70 pg/ml in the Framingham Heart Study sample. As sex hormonebinding globulin levels may be elevated in some men with cancer (resulting inelevation in total testosterone level), some of these symptomatic men may still behypogonadal despite having total testosterone above this cut-off limit, but theirfree testosterone levels may still be below the lower limit of normal. Thus, menwith free testosterone <70 pg/mL will be included.

• Fatigue. Fatigue was selected as it is a highly prevalent symptom in cancerpatients. Fatigue will be defined as a score on FACIT-Fatigue subscale of <40, whichbest divides cancer patients from the general population with accuracy.

• Ability and willingness to provide informed consent

Exclusion Criteria:

• Men with current or prior history of prostate, breast, testicular, or adrenalcancers.

• Use of anabolic agents (testosterone, DHEA, growth hormone) within the past 6 months

• Hematocrit >48%, serum creatinine >2.5 mg/dL

• PSA >4 ng/ml; nodule or induration on digital rectal exam

• Severe untreated sleep apnea

• Uncontrolled congestive heart failure

• Myocardial infarction, acute coronary syndrome, revascularization surgery, stroke orthromboembolism (of any etiology) within 6 months

• Known history of thrombophilia due to a genetic mutation (e.g. Factor V Leiden)

• Previous stroke with residual cognitive or functional deficits

• Inability to provide informed consent; MMSE score <24

• Poorly controlled diabetes as defined by hemoglobin A1c >10.0%

• Body mass index (BMI) >40 kg/m2

• Bipolar disorder or schizophrenia