Importance of sexual function assessment in multidimensional evaluation of AGHD patients: Baseline results from the management of adult growth hormone deficiency (MAGHD) study.

Background Patients with adult growth hormone deficiency (AGHD) have impaired health-related quality of life (QoL). While the effects of reduced muscle mass and vitality-loss on QoL have been well characterized in AGHD, the impact of AGHD on sexual function, a recognized factor influencing well-being, has never been deepened. Aim To investigate the prevalence of sexual dysfunction in AGHD patients re- ferring to a single endocrinological center and grouped according to their history of r-hGH therapy. Methods The MAGHD Study aims to improve management of AGHD patients through a smartphone app (MAGHD-App) and a fit-watch. The 83 enrolled patients (31 Females, 52 Males, mean age 56.27 ± 14.68 years) were divided in 3 groups (G) according to r-hGH therapy: on long-term treatment (G1, n=32), previously treated (G2, n=20), never treated (G3, n=31). At the baseline visit, besidesclinical and biochemical data, a psychological assess- ment was performed. IIEF-15 (for males) and FSFI (for females) were em- ployed to evaluate sexual function in addition to QLS-H and QoL-AGHDA routinely used to assess QoL. The nonparametric Kruskal-Wallis test was used for comparison among 3 groups. Results According to IIEF-15 results, the prevalence of erectile dysfunction (ED) in AGHD males was 60%. Erectile function (EF) score was significantly high- er in G1 compared to G2 and G3 (P < 0.05) with an ED prevalence of 37.5% in G1, 75% in G2 and 75% in G3. Even excluding interfering factors (serum testosterone <2ng/ml and age ≥65 years), ED prevalence did not change significantly. Moreover, EF domain was inversely and directlycorrelated to age (R2 0.130, β–0.360) and IGF1 levels (R2 0.156, β 0.395), respectively. The prevalence of female sexual dysfunction according to FSFI was 89%. Even though desire, arousal, lubrication and overall scores were significant- ly higher (better results) in G1 compared to G2 and G3 (P<0.05), no cor- relation resulted between FSFI domains and IGF1 levels. Only an inverse correlation resulted between desire domain and age. Conclusions This real-life study documents a high prevalence of sexual dysfunction in AGHD patients, especially in untreated ones, and that r-hGH treatment seems to be associated to better sexual outcomes. These results suggest that the evaluation of sexual function should be integrated into global assessment of AGHD patients since sexual activity is able to influence both well-being and QoL.