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Male fertility problems

Every man, including men who have never had cancer, can experience reduced fertility, testosterone deficiency, or sexual problems. However, some cancer treatments can increase the risk of these problems. It is important that you recognize and understand the symptoms and signs that may indicate these problems.

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What are fertility problems in men?

The male reproductive organs consist of the testicles and the penis. The pituitary gland in the brain produces LH hormones that signal the testicles to produce sperm and testosterone.

Testosterone is a male hormone that is produced in the Leydig cells in the testicles. During puberty, testosterone causes the penis and testicles to grow, body hair to increase, and muscles to develop further. After puberty, testosterone ensures that the testicles continue to function and produce sperm.

Sperm consists of fluid and sperm cells. To be able to conceive a child, there must be sufficient sperm cells of good quality in the semen.

Sometimes problems arise such as failure to conceive, reduced sex drive, difficulty getting or maintaining an erection, or problems with ejaculation.

Do I have an increased risk of reduced fertility, testosterone deficiency, and sexual problems?

Every man, including men who have not had cancer, can experience reduced fertility and develop testosterone deficiency or sexual problems. However, some cancer treatments can increase the risk.

Treatments that increase the risk of reduced fertility:

  • Radiation to the pituitary gland

  • Radiation with radioactive iodine to the thyroid

  • Alkylating chemotherapy such as cyclophosphamide and procarbazine

  • Any dose of radiation to the testicles or to an area where the testicles are located

  • Surgery in which one or both testicles have been removed

Treatments that increase the risk of testosterone deficiency:

  • Radiation (12 Gy or more) to the testicles or to an area where the testicles are located

Treatments that increase the risk of sexual problems:

  • Testosterone deficiency

  • Radiation to the pelvis or to an area where the pelvis is located

  • Surgery of the pelvis, spinal cord, or nerves that control the reproductive organs

Fertility problems, testosterone deficiency, and sexual problems can also have other causes.

What are the symptoms and signs?

Certain symptoms and signs may indicate these problems. It is important to recognize them.

Reduced fertility:

  • Failure to conceive for at least 6 months

  • Low sperm count (less than 5 million per ml)

  • Poor quality of sperm cells

Testosterone deficiency in children:

  • No signs of puberty at age 14

  • No further pubertal development for at least 6 months

Testosterone deficiency in adults:

  • Low sex drive

  • Difficulty getting or maintaining an erection

  • Decrease in muscle mass

  • Loss of body hair

  • Difficulty with ejaculation

  • Early, slow, or absent ejaculation

If you experience symptoms, contact your general practitioner or LATER physician.

What tests are necessary and when?

  • From age 10-12, annual monitoring of growth and puberty in case of radiation (12 Gy or more) to the testicles

  • After puberty, have a sperm analysis performed

  • Have testosterone levels measured in the blood at least every 2-3 years

  • Visit your general practitioner or LATER physician at least every 5 years in case of surgery of the pelvis, spinal cord, or controlling nerves

What happens if I have reduced fertility, testosterone deficiency, and/or sexual problems?

Your general practitioner or LATER physician will likely refer you to a:

  • Endocrinologist

  • Fertility specialist

  • Urologist

These specialists will discuss treatment options with you, such as hormone therapy or artificial insemination. Never take testosterone on your own without consulting your doctor.

What else can I do?

If you wish to have children, artificial insemination may be possible. If you have previously frozen sperm cells, these can be used for:

  • Insemination

  • IVF

  • ICSI

If having your own child is not possible, you can consider donor sperm or adoption.

Living with these problems can be difficult. Contact with others or a patient association such as VOX can help. A healthy lifestyle and attention to your mental health remain important.

Where can I find more information?

  • Healthy lifestyle

  • Mental health

In the PanCare Plain Language Summaries you will find links to reliable information in English.

Disclaimer

This information is based on the plain language summary of the PanCare Plain Information Group guideline and adapted to the Dutch LATER guideline. If you experience symptoms, always contact your general practitioner, LATER physician, or specialist.

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