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Hypogonadism Risk in Men Treated for Childhood Cancer

Departments of Pediatrics (P.R., C.M., T.W.) and Oncology (O.S., T.R., E.C.-S.), Lund University Hospital, Lund SE-221 85, Sweden; Reproductive Medicine Centre (P.R., O.S., A.G.), Malmö University Hospital, Malmö SE-205 02, Sweden; and Department of Clinical Sciences (P.R., O.S., Y.L.G., A.G.), Lund University, Malmö SE-205 02, Sweden

Address all correspondence and requests for reprints to: Aleksander Giwercman, Reproductive Medicine Centre, Malmö University Hospital, Entrance 74, SE-205 02 Malmö, Sweden. E-mail: aleksander.giwercman{at}med.lu.se.

Context: Pediatric cancer treatment may imply an increased risk of hypogonadism, leading to metabolic disorders and osteoporosis. Such complications are potentially preventable.

Objective: The aim of this study was to assess diagnosis- and treatment-dependent risk of hypogonadism in male childhood cancer survivors (CCS).

Design: Male CCS who were treated during the period 1970–2002 and who in 2004 were 18–45 yr of age were eligible.

Setting: The study was conducted in a university hospital clinic.

Patients: A consecutive group of CCS treated at Lund University Hospital was selected for the study, of whom 151 (38%) agreed to participate. Furthermore, 141 healthy fertile men served as controls.

Interventions: We measured serum levels of free and total testosterone, SHBG, and LH.

Main Outcome Measures: Odds ratios (OR) for biochemical hypogonadism, defined as total testosterone less than 10 nmol/liter and/or LH above 10 IU/liter, were calculated and related to type of cancer, treatment received, as well as testicular volume.

Results: Hypogonadism was more commonly detected in CCS than in controls (OR, 6.7; 95% CI, 2.7, 17). The increased presence of hypogonadism was noted in the following treatment groups: brain surgery, chemotherapy (with and without radiotherapy), and testicular irradiation. Low total testicular volume (24 ml) was associated with a high risk of hypogonadism (OR, 31; 95% CI, 11, 92).

Conclusion: Adult male survivors of childhood cancer are at risk of hypogonadism, which should be acknowledged in the long-term follow-up of these men.