We studied the gonadal function in 21 male patients with Hodgkin's disease (group A), who had received chemotherapy during childhood and adolescent, and compared them to 20 healthy young men (group B). The median age at the time of the study was 18 years (17-23), and at the time of chemotherapy, 10 years (6-19). At that time, 14 were prepubertal and 7 pubertal; by the time of the study all were Tanner V, and had completed chemotherapy 3 to 11 years previously. The median testicular volume was significantly higher in patients than controls (p= 0.001). No significant differences were found in TT, SHBG, PRL and LH concentrations between patients and controls. The median serum FSH concentration was significantly higher in patients than controls (p= 0.0001). We detected an appreciable difference in peak FSH and LH levels after a GnRH test in group A and B (p= 0.002 and p= 0.0002, respectively). We observed a positive correlation between the age of the patients at the time of treatment and peak LH levels (r= 0.4; p= 0.03), and a negative correlation with the period of time between the end of treatment and the study (r= -0.5; p= 0.008). Eleven patients had azoospermia, 4 oligospermia and 3 patients had a normal semen analysis; one had recovered fertility, with normalization of sperm count 11 years after the end of the treatment. We conclude that chemotherapy causes severe damage to germinal epithelium in children treated during prepubertal and adolescent age. Normal testosterone levels may be secondary to compensated LH secretion. Reduction of testicular size in these patients suggests germ cell damage. Long-term follow up is necessary to establish whether the gonadal function will recover.
Hodgkin’s disease; Chemotherapy; Male gonadal function; Semen analyses
