Hypogonadism and Infertility in Testicular Cancer Survivors

Testicular cancer is the most common cancer in men in their 20s and 30s, and has been considered a model of a curable neoplasm. The longer life expectancy of testicular cancer survivors makes minimizing the long-term health issues related to hypogonadism particularly important, and because testicular cancer affects men mostly in their reproductive years, infertility can also be a major concern. Hypogonadism, infertility, and testicular cancer have been associated with one another. These associations suggest the existence of common etiologic factors, including improper testicular development during fetal life. The effect of cancer treatment on testosterone, luteinizing hormone, and follicle-stimulating hormone levels, and on fertility and overall paternity rates among testicular cancer survivors, are potentially significant issues. As the biologic mechanisms underlying hypogonadism, infertility, and testicular cancer become clearer, more research is needed to provide clinicians with evidence-based guidelines for the management of testicular cancer survivors. (JNCCN 2012;10:558-563)