Late Effects	Causative Treatment	Signs and Symptoms	Screening and Diagnostic Tests	Management and Intervention
aAdapted from Schwartz et al.[37]
Germ cell damage: oligospermia/ azoospermia	Chemotherapy: Cyclophosphamide, mechlorethamine, lomustine (CCNU)/carmustine (BCNU), procarbazine, ifosfamide, busulfan, melphalan, dacarbazine (DTIC)	Testicular atrophy (softer and smaller), failure to impregnate	Tanner stage, inquire regarding previous sperm banking, determine testicular size and consistency, LH, FSH, testosterone: (1) for failure of pubertal development, (2) baseline when sexually mature, (3) for failure to impregnate (repeat every 3 years for possible recovery), analysis of sperm at maturity, or for failure to impregnate (repeat every 3–5 years to assess recovery)	Instruct on testicular self-examination, anticipatory guidance regarding germ cell damage, referral to reproductive endocrinology, infertility counseling, and alternate strategies for fathering
	Radiation: >1–6 Gy
	Surgery: Orchiectomy or surgical manipulation
Leydig cell damage: testosterone deficiency	Chemotherapy: Cyclophosphamide/etoposide	Delayed/ arrested/ absent pubertal development, pubic and axillary hair (female hair pattern), lack of penile and testicular enlargement, voice change, body odor and acne, testicular atrophy (softer and smaller)	LH and testosterone at age 13 years, failure of pubertal development; baseline, if sexually mature; changes in libido or sexual performance	Testosterone replacement and anticipatory guidance regarding testosterone deficiency
	Radiation: >24 Gy to the testes (direct or scattered from pelvis)
	Surgery: Orchiectomy

References

37. Schwartz C L, Hobbie WL, Constine LS, et al., eds.: Survivors of Childhood Cancer: Assessment and Management. St. Louis, Mo: Mosby, 1994.