Chemotherapy

Content written by John P. Mulhall, MD

Chemotherapy involves the use of medications that target the most rapidly dividing cells in the body and kills them. Typically the most rapidly dividing cells in a person’s body are cancer cells, which are cells that have unregulated growth and proliferation. However, other cells in the body also proliferate with great rapidity and these too will be targeted and damage by chemotherapy. Such cells include the sperm producing cells of the testis, the testosterone producing cells in the testis, the lining of the gastrointestinal tract, and the cells of the hair follicles. Thus, chemotherapy side effects include, among many other problems, sperm production, a reduction in testosterone production, nausea and vomiting and loss of hair. Modern chemotherapy now utilizes targeted chemotherapy, which is the use of drugs, which have been specifically designed to attack certain enzymes known to be active in certain cancers. The most obvious example of this has been the use of Gleevec in the treatment of CML (chronic myeloid leukemia). The effect of chemotherapy on a man’s sexual function will be largely related to the effect of the chemotherapy on his testosterone production. The impact of chemotherapy on testicular function depends on the type of chemotherapeutic agents used, the dose utilized, the duration of treatment and whether the patient was exposed to single or multi-agent treatment. While beyond the scope of this section, certain agents are notorious for causing testicular damage, in particular the alkylating agents, such as cyclophosphamide, procarbazine and melphalan. It is my recommendation to all patients about to undergo chemotherapy that they check an early morning serum total testosterone level and that close attention be paid to this level following treatment. I have seen many men years after chemotherapy who have never had a testosterone level checked following treatment, who have lived their lives with this dramatically low testosterone levels which has not only altered their quality of life but put them at risk for other serious medical conditions, including type 2 diabetes at osteoporosis. Low testosterone from the sexual standpoint is most commonly associated with loss of libido but may also negatively impact upon erectile function and may be associated with delayed orgasm in some men. From a fertility standpoint all males capable of procuring a semen specimen should be encouraged to bank sperm prior to chemotherapy and have a semen analysis performed at some stage after the completion of treatment generally at 12 months following the cessation of chemotherapy.