Gonadotoxic

Gonadotoxic refers to agents or processes that cause damage to the gonads—the ovaries in females and the testes in males—with potential consequences for fertility and hormonal function. Gonadotoxicity is a key consideration in medical treatments and in certain environmental and occupational exposures.

Causes include cancer therapies (chemotherapy regimens that use alkylating agents such as cyclophosphamide, ifosfamide, and others; platinum-based drugs), pelvic or whole-body irradiation, and conditioning regimens for stem cell transplantation. Environmental toxins, radiation exposure, and certain infections or inflammatory conditions can also contribute. The risk is influenced by the type and dose of exposure, duration, the patient’s age and sex, and the remaining gonadal reserve.

Mechanisms vary but commonly involve direct DNA damage to germ cells, disruption of supporting gonadal tissue, and vascular injury that impairs blood supply. In females, gonadotoxicity can lead to decreased ovarian reserve and premature ovarian insufficiency, with menstrual changes and potential infertility. In males, it can cause azoospermia or oligospermia and, in some cases, reduced testosterone production.

Assessment and management emphasize fertility counseling before exposure, and monitoring of gonadal function afterward. Fertility preservation options exist, including sperm banking for males and oocyte or embryo cryopreservation or ovarian tissue cryopreservation for females; some approaches are experimental or have limited availability. Dose reduction, shielding, and careful treatment planning aim to minimize risk when possible. The long-term impact on quality of life can be significant, highlighting the importance of early multidisciplinary discussion.