Background: Surgery, chemotherapy and radiation, but also long-term hormonal treatment may cause reduced gonadal function in male cancer patients. The germinal epithelium is more vulnerable to cytotoxic damage than the Leydig cells, which implies that subfertility/infertility is a more frequent side effect of cancer treatment than endocrine hypogonadism.
Material and methods: This review article is based on clinical experience and literature retrieved from PubMed.
Results and interpretation: The degree of gonadal damage depends on the type of chemotherapy and the cumulative dose; with alkylating substances and procarbazine being the most gonadotoxic agents. The testicle is one of the most radiosensitive organs, and the damage depends on the radiation dose. Testicle damage may be caused by direct radiation of the testicles or scattered radiation from radiated adjacent tissue. Freezing of semen should be discussed with and offered to all men below 55 years that are about to undergo cancer treatment that may cause reduced fertility. Men surviving cancer who experience unwanted childlessness should be offered examination, advice and possibly assisted fertilization as part of the rehabilitation. Especially after intensive chemotherapy and high dose cranial radiation therapy the patient should be examined regularly throughout life with respect to premature endocrine hypogonadism.