Testicular cancer, sex and fertility

Treatments for testicular cancer do not usually affect your ability to have sex. But a diagnosis of testicular cancer can cause a lot of feelings. This may affect your sex drive (libido) for a time.

Treatment side effects may also mean you have a lower sex drive. If you have a partner, let them know how you feel. It can take time to recover physically and emotionally.

If you find you have a low sex drive, this will usually improve as your feelings get easier to cope with and you recover from treatment. If you are having sexual difficulties, there is support available.

Removing one testicle does not usually affect your sex drive. The remaining testicle should make enough testosterone on its own.

Sometimes the remaining testicle does not produce enough testosterone. Or, rarely, both testicles have to be removed because of cancer.

A lack of testosterone can:

• affect your ability to get an erection
• reduce your sex drive
cause tiredness, low mood and problems such as thinning of the bones (osteoporosis).

Tell your doctor if you are having these or any other symptoms. They can measure your testosterone level with a blood test. If it is low, your doctor may be able to prescribe testosterone replacement therapy to improve your symptoms. You can have it as a gel, an injection into a muscle, an implant, or a patch that you stick to the skin. Your doctor can give you more information about testosterone replacement therapy.

Treatment for testicular cancer usually does not affect your ability to make someone pregnant (your fertility). But even if your chances of becoming infertile are low, your doctor usually advises you to store (bank) sperm. You usually do this before having an orchidectomy. If this is not possible, it is important to do it before you have any further treatment.

If you are trans or non-binary, considering the possible effect on your fertility may feel even more overwhelming. But it is important to know your options about preserving fertility so you can make an informed decision. You can talk to your specialist doctor or nurse about any concerns you might have about this.

There is no evidence that cancer treatments can harm children you have (conceive) after treatment. It is usually possible to make someone pregnant if you have had treatment for testicular cancer, after you have recovered.

But doctors usually advise you to continue using contraception for about 1 year after radiotherapy and chemotherapy, to avoid making someone pregnant. This allows your sperm time to recover from any damage that treatment may have caused. If you are planning on having a family, you can talk to your doctor or nurse about having your sperm count checked. Your GP can also advise you on this.

Even if your chances of becoming infertile are low, your doctor will usually advise you to store some sperm. They will talk to you about this before you have your operation. If it is appropriate for you, you usually store sperm before you have an orchidectomy. But if this is not possible, it is important to do it before you have any further treatment. This is because this treatment could damage your sperm.

You will have counselling at the fertility clinic before you store your sperm. You also need to sign a consent form that states how your sperm will be used. You will have blood tests as well. These will check your general health, and for infections such as HIV or hepatitis.

Sperm banking is a safe technique that has been used for many years. It involves freezing your sperm. If you want to have a child later in life, your sperm can be used with fertility treatments. The usual period of time for storing sperm is 10 years. But, in some circumstances, you may be able to store it for longer. People affected by cancer may be able to store their sperm for up to 55 years.

Sometimes the NHS pays for sperm banking for people with cancer. But it varies across the UK, and in some hospitals you may have to pay for it yourself. Even if the hospital pays for storage to begin with, you may need to pay if you choose to store sperm for a longer period of time. The staff in the fertility clinic or your specialist doctor or nurse can explain more about this. If you have to pay, the average yearly cost is between £175 and £450 per year.

Sometimes treatment needs to start straight away, and there is no time to take sperm samples. If your doctor feels your treatment needs to start straight away, they will talk to you about this. You may still be able to store sperm if you do it in the first few days of starting chemotherapy.

If you are trans or non-binary, you may find the thought of giving a sperm sample very difficult. It may help to talk to a:

• gender identity clinic, if you attend one
• sexual health and well-being service that is trans and non-binary friendly. You can check if this is available in your area on Tranzwiki.

The fertility clinic at the hospital may also be able to give you advice and support.

If you are not producing enough sperm, or you started treatment too quickly to give enough samples, you can still store sperm.

It is possible to collect sperm by taking a piece of testicular tissue or some fluid. Doctors can remove small amounts of testicular fluid or tissue by putting a fine needle into the testicle. Or they can make a small cut in the scrotum. They can do this using a local or general anaesthetic. The fluid or tissue is checked for sperm in the laboratory. The sperm is then removed and stored for future use. Your doctor or nurse at the fertility clinic can give you more information about these techniques.

We have more information about sexuality and cancer and cancer treatment and fertility.