No effect

Temporary oligospermia Complete recovery by 12 months Temporary azoospermia at 4-12 months following irradiation 100% recovery by 48 months 100% temporary azoospermia for

3-17 months from irradiation Recovery beginning at 8-26 months 100% azoospermia from 2 months to at least 9 months Recovery beginning at 11-20 months with return of sperm counts at 30 months 100% azoospermia beginning at

1-2 months Some will suffer permanent azoospermia; others show recovery starting at 12-14 months Reduced testicular volume 100% azoospermia

No recovery observed up to 40 months All have reduced testicular volume

Permanent azoospermia Reduced testicular volume

Permanent azoospermia Reduced testicular volume

No effect No effect

Transient rise in FSH with eventual normalization

Transient rise in FSH and LH No change in testosterone

Prolonged rise in FSH with some recovery Slight increase in LH No change in testosterone

Permanent elevation in FSH Transient rise in LH Reduced testosterone response to hCG stimulation Elevated FSH and LH Low testosterone Decreased or absent testosterone response to hCG stimulation Testosterone replacement may be needed to ensure pubertal changes Effects more severe and profound than at 12 Gy Prepubertal testes appear more sensitive to the effects of radiation Replacement hormone treatment probably needed in all prepubertal cases

Notes. FSH, follicle-stimulating hormone; LH, luteinizing hormone; HCG, human chorionic gonadotropin. From Leventhal BG, Halperin EC, Torano AE. The testes. In: Schwartz CL, Hobbie WL, Constine LS, Ruccione KS, editors. Survivors of Childhood Cancer: Assessment and Management. St. Louis: Mosby, 1994:225-44, with permission.

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