Puberty hormone levels could offer an early warning of future fertility problems in men who survived childhood cancer, according to a cohort study of 221 male survivors. Researchers found that testicular radiotherapy was linked to persistent impairment of testicular function, while there was evidence of hormonal recovery among survivors treated with intermediate doses of alkylating chemotherapy. The findings, published in JAMA Network Open, suggest that monitoring reproductive hormones during adolescence could help identify survivors who may benefit from early fertility counselling.
The study included men diagnosed with cancer before the age of 17 between 1964 and 2000. Researchers measured follicle-stimulating hormone (FSH), luteinising hormone (LH), and testosterone at two-year intervals between ages 12 and 18 years, and again in adulthood. Cancer treatments were assessed based on testicular radiotherapy and cumulative alkylating chemotherapy doses, quantified using the cyclophosphamide equivalent dose.
FSH levels rose in a dose-dependent pattern after testicular radiotherapy, with elevations apparent from age 12 among survivors who received more than 1 Gy, a unit of radiation dose. Higher FSH levels during puberty were associated with azoospermia in adulthood, defined as the absence of sperm in semen. The researchers identified optimal FSH thresholds for predicting adult azoospermia: 11.2 IU/L at age 14 and 12.5 IU/L at age 16. The predictive analysis achieved an area under the curve of 0.87, indicating strong accuracy. Elevated LH levels were also observed from age 12 among survivors exposed to more than 14 Gy of radiotherapy. Overall, radiotherapy-associated testicular impairment persisted into adulthood.
Chemotherapy produced a different picture. At age 18, FSH levels were higher among survivors who received intermediate or high cumulative doses of alkylating chemotherapy than among those given less than 4 g/m². However, hormone levels showed signs of normalisation in adulthood among those who received intermediate doses of 4 to less than 12 g/m². No such recovery was seen among survivors exposed to 12 g/m² or more.
Notably, high cumulative chemotherapy exposure was not associated with impaired Leydig cell function, which contributes to testosterone production. The findings suggest that sperm-producing cells may be more sensitive to treatment-related damage than testosterone-producing cells.
The authors concluded that pubertal hormone measurements could help inform fertility counselling for male childhood cancer survivors. They cautioned, however, that further validation is needed before the proposed FSH thresholds can be routinely applied in clinical practice.
Reference: Koskela M et al. Pubertal testicular function in childhood cancer survivors and future fertility. JAMA Netw Open. 2026;9(10):e2638294.
Original Source: https://www.emjreviews.com/urology/news/fertility-after-childhood-cancer-linked-to-pubertal-hormone-levels/
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Publish Date: 2026-10-17 17:33:00
