Many drugs, particularly alkylating agents, are gonadotoxic, and the agents most commonly implicated are listed in table Table 1. The germinal epithelium is far more sensitive to the effects of cytotoxic drugs than are the Leydig cells, and, although complete azoospermia is not uncommon after chemotherapy, evidence of Leydig cell dysfunction is usually limited to raised luteinizing hormone (LH) levels with normal or low normal testosterone levels. Most research has focused on either cyclophosphamide given alone for immunologically mediated disease or combination chemotherapy used in the treatment of hematological malignancies and testicular cancer.

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