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

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 antiandrogen 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 affected homosexual men more than heterosexual men, although not all heterosexual men were unaffected. These results are discussed in the context of dual sexual natures, a concept recently developed in the sexual literature. Furthermore, these findings reiterate the importance of incorporating such variables as sexual orientation into studies investigating medical treatments on sexual response.