Testicular surgery can affect production of sperm and hormones or interfere with transport of sperm from the testes to the urethral opening. Impaired production may occur from removal of one or both testes or injury of the gonadotropin releasing hormone area of the hypothalamus and/or the gonadotropin producing area of the pituitary. Impaired transport may occur from damage to autonomic nervous system control of urethral sphincters and/or vasodilation secondary to retroperitoneal lymph node dissection or prostatectomy.
Direct testicular radiation can impair hormone production and/or spermatogenesis. Spermatogenesis is more sensitive to radiation therapy damage than hormone production. However, both spermatogenesis and hormone production can be impaired after radiation therapy delivered to the hypothalamic/pituitary area. Spermatogenesis is very sensitive to damage by several alkylating agents including nitrogen mustard, procarbazine, cyclophosphamide, ifosfamide, chlorambucil and busulfan.