Dear Dr. G,

I read with interest about the Movember feature on cancer and men and how different cancers affect certain age groups.

On this, I am sad to say that my new year did not start well; I discovered a lump on my right testicle and after blood scans and tests, I was diagnosed with testicular cancer at the age of 28.

Having said that, I am optimistic after reading articles about the successful treatment of testicular cancer. However, I am concerned as to whether I can keep my virility after losing a testicle.

My urologist has assured me that my virility will be preserved after surgery, but there are questions I find difficult to ask and hope to get some clarification by putting Dr G on the spot.

First of all, I understand that there could be less sperm ejaculated after the removal of a testicle – so how much of a reduction are we talking about? There are also indications of further treatment that may render me infertile, what are these interventions and how could they impact on my virility?

I am also unclear how sperm banking is done; what is it and how is the sperm kept?

(About to be) Ball-less Bob

Testicular cancer occurs in the testicles, which are responsible for the production of sperm and male sexual hormones. Testicular cancer is relatively uncommon, however it uniquely affects young men between the ages of 18 to 40, at their peak age of sexual and reproductive functions.

Testicular cancer itself is highly treatable, as the cure rate can be as high as 95%. Depending on the type and stages of testicular cancer, several treatments options are often necessary to eliminate the cancer.

It is normal to worry about the possible adverse effects of testicular cancer on sex life and fertility. In general, the treatments for testicular cancer may cause some adversity temporarily, but do not affect sex life and fertility in long term.

The removal of one testicle, or orchidectomy is necessary to get rid of the primary tumor. The operation itself will not affect the ability to get an erection, providing the other testicle is healthy and it will continue to produce sufficient sperm to father children.

Adjuvant chemotherapy after orchidectomy is also commonly recommended to reduce the chances of recurrence. The treatment itself often causes a temporary reduction of libido and sperm production. Sexual and reproductive functions

tend to return to normal about 18 months to two years after treatment, but recovery can take up to five years. Aside from this, other additional treatment may be also necessary for testicular cancer patients such as Para Aortic Lymph Node dissection.

The intervention can potentially result in nerve injury that causes retrograde ejaculations of sperm instead of forward propulsion. This certainly can impair fertility, but has no adversity on erection or sexual climax.

We have come to an era when technology has allowed for fertility to be preserved in the sperm bank for generations to come. A sperm bank is a facility or enterprise collecting and storing human gametes.

Sperm banking began as early as 1964 and this has led to 1 million babies being born in the last 50 years. In most countries, regulators such as the HFEA (Human Fertilization and Embryology Authority) impose strict rules on the establishment of such banks.

Individuals who intend to freeze their sperm are typically screened for range of diseases including sexually transmitted diseases such as Syphilis, HIV and Hepatitis.

The process of sperm banking starts with semen collection at a clinic by masturbation in a private room. After collection, the samples must be processed for storage, including the removal of unwanted particles and the addition of buffer solutions to preserve the sperm.

The processed samples are stored in small vials between 0.4ml and 1.0ml, cryogenically preserved in liquid nitrogen tanks. Technically, the samples can be frozen indefinitely; the United Kingdom government places an upper limit for storage of 55 years. However, a healthy baby has been born after using sperm frozen for 21 years.

The word virility is derived from Latin “Virilitan” referring to the wide range of masculine characteristics including vigor, strength and sturdiness. In many aspects, it also reflects the constitutional ability of a man to father children.

In the modern context, the sense of male-dominant virility for the purpose of procreation may seem irrelevant, as science has effectively bypassed the necessity of sex to create the next generation.

When facing the trauma of losing a testicle, the worries of future prospects of normal virility, especially fertility, are often looming. Benjamin Franklin famously said: “Lost time is never found again.” In the fight for cancer, time is of the essence to ensure cure. Men facing the challenges of testicular cancer often put Dr G on the spot, contemplating the loss of his virility after losing his ball to cancer. His view is “Freezing the virility can definitely ensure no lost time or lost minds, despite losing a ball!”

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