Andrological Outcomes in Boys Undergoing Testicular Tissue Extraction Prior to Gonadotoxic Treatment: Evolution During Peripuberty and Young Adulthood.
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OBJECTIVE: Advances in oncological and haematological treatments have markedly improved childhood survival, yet gonadotoxic therapies often compromise testicular function. Testicular tissue extraction (TTE) with cryopreservation is increasingly offered to prepubertal boys at high risk of infertility; however, data on long-term endocrine and fertility outcomes remain limited. This study evaluated the long-term endocrine and exocrine testicular function of males who underwent TTE prior to gonadotoxic therapy. DESIGN AND PATIENTS: This was a retrospective, observational, single-centre study including 50 males treated between 2009 and 2022 at Lille University Hospital (median age at TTE: 5.6 years; median age at last follow-up: 14.6 years). Underlying conditions comprised malignant haematological disorders (52%), non-malignant diseases (34%), and solid tumours (14%); 80% underwent allogeneic haematopoietic stem cell transplantation. MEASUREMENTS: Serial clinical assessments and biochemical markers of Leydig and Sertoli cell function (LH, FSH, testosterone, inhibin B, AMH) were recorded from puberty onset to young adulthood. Data were stratified by treatment intensity, pubertal timing, and disease type. Post-pubertal semen analysis was performed in consenting individuals. RESULTS: All participants experienced spontaneous pubertal onset. Sertoli cell dysfunction, evidenced by elevated FSH and persistently low inhibin B, was detectable early in puberty and persisted into adulthood. At Tanner stage 5, 18% had elevated LH, 75% elevated FSH, and 89% low inhibin B; comparable rates were observed in adulthood. Radiotherapy was associated with higher gonadotropin levels at equivalent chemotherapy doses, and Sertoli cell impairment was more pronounced in malignant disease and peri-pubertal treatment. Among 12 semen analyses, spermatozoa were detected in 42%, all in non-malignant cases without radiotherapy. CONCLUSIONS: Males undergoing TTE prior to gonadotoxic therapy frequently develop persistent Sertoli cell dysfunction, with limited fertility potential in many cases. These findings underscore the importance of systematic, long-term andrological surveillance and personalised fertility counselling in this high-risk population.