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Male Reproductive Health Issues

Childhood cancer therapy may sometimes affect male reproductive functions later in life.

The effect, if any, depends on the:

  • Tissues and organs involved in the cancer
  • Type, dosage, and combination of treatment administered
  • Child’s age at the time of therapy

How the Male Reproductive System Works

The testicles are located in a loosely hanging pouch of skin known as the scrotum. When boys enter puberty, the pituitary gland in the brain releases two hormones that instruct the testicles to begin producing sperm and testosterone.

When sperm fertilizes the egg of a female, she becomes pregnant. Testosterone also regulates male functions such as:

  • Deepening of the voice
  • Enlarging of the penis and testicles
  • Increasing the growth of facial and body hair
  • Enhancing muscular development
Testes are part of the male endocrine system. When boys enter puberty, the pituitary gland releases two hormones that tell the testes to produce sperm and testosterone.

Testes are part of the male endocrine system. When boys enter puberty, the pituitary gland releases two hormones that tell the testes to produce sperm and testosterone.

Cancer Treatments That May Affect Male Health

  1. Chemotherapy with high doses of alkylating drugs can damage sperm.

    Alkylating Drugs
    Heavy  Metal Drugs
    Non-classical alkylators
  2. Radiation therapy to patient’s pelvic area, reproductive organs, and pituitary gland may affect a patient’s fertility.

    Testicular/pelvic/total body radiation

    Sperm-producing cells are highly sensitive to radiation therapy. Males who have radiation to the pelvic area are at risk for low sperm count.

    Testosterone-producing cells are more resistant to the effects of radiation and chemotherapy unless given in high doses. But if males receive high doses of radiation, testosterone deficiency could occur.

    Brain/hypothalamus/pituitary gland

    The pituitary gland produces 2 hormones needed for the testicles to function correctly – follicle-stimulating hormone (FSH) and luteinizing hormone (LH). High levels of radiation to this area of the brain can lead to low levels of these hormones. FSH stimulates growth of testicles and the production of a protein that aids in sperm production. LH causes the production of testosterone.

    Pelvic radiation and alkylating agent combination

    The combination of pelvic radiation and high doses of alkylating agents causes the highest risk of damage.

  3. Surgical procedures that may also cause infertility or disrupt normal sexual functioning include:

    • Tumors and / or surgery that result in damage to the pituitary gland can cause the testes to stop working due to deficiency in LH and FSH; this condition is called central hypogonadism.
    • Removal of both testicles – This procedure will result in infertility and testosterone deficiency.
    • Pelvic surgery (retroperitoneal lymph node dissection-RPLND) or spinal surgery – The procedure may result in nerve damage that prevents the ejaculation of sperm.
    • Removal of prostate or bladder – Either of these procedures may result in difficulties achieving an erection or ejaculation.
    • Spinal surgery or removal of a tumor near the spinal cord – These procedures may cause nerve damage.

Problems That May Occur

  1. The condition is also known as hypogonadism. It can delay puberty (no signs of puberty after age 14 years) or cause it to stall (no progress in puberty) in affected young boys.

    After puberty, it may cause problems with:

    • Muscle development and strength
    • Bone strength
    • Appropriate distribution of body fat
    • Sex drive
    • Ability to have erections
  2. Males may experience problems with having and maintaining an erection or with ejaculation of sperm.

  3. Infertility in men is the inability to fertilize an egg to cause a pregnancy. Infertility will be permanent for males who had both testicles surgically removed. They will no longer be able to produce sperm. Infertility following radiation is generally permanent.

    Infertility is unrelated to sexual function. In some men there are no physical signs or symptoms of infertility. Others may notice a decrease in the size or firmness of the testicles.

    Males who have had one testicle surgically removed may not have problems with fertility or testosterone deficiency. But these males should protect the remaining testicle from injury. They can wear an athletic supporter with a protective cup when participating in activities that could injure to the groin area.

What Survivors Can Do

It is important that boys who are at risk for reproductive health problems have a yearly check-up that includes checking of growth and the progress of puberty.

Males at risk for reproductive health problems should have their hormone status evaluated. This evaluation may include blood tests for levels of FSH, LH, and testosterone. If the health care provider sees problems in these areas, he or she may refer the survivor to an:

  • Endocrinologist – hormone specialist. Males who have had both testicles removed should have regular checkups with an endocrinologist starting at about age 11.
  • Urologist – specialist in the male reproductive organs
  • Fertility specialist – a physician with additional training in reproduction

Addressing Testosterone Deficiency

If testosterone deficiency is suspected, treatment may include testosterone replacement therapy. Testosterone is available in skin patches, injections, and topical gel. An endocrinologist will determine which form of therapy is best.

Infertility Options

Sexually mature males who are concerned about possible infertility should have a semen analysis. If sperm counts are low or not present, men should have the test repeated. Sperm counts may recover over time. Also, sperm count can vary from day to day.

Not all insurance companies cover this procedure. Survivors should check before having the test.

Males have treatment options for infertility or low sperm count. Males who banked sperm before treatment should consult with a fertility specialist when ready to father children.

Continue to use birth control

Men should not rely on low sperm counts to prevent pregnancy, as pregnancy can occur with low sperm counts.

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Reviewed: June 2018