When we think of cancer treatment, we often focus on the immediate goals: Shrinking tumors, stopping the spread of the disease, and ultimately aiming for a cure. What doesn’t get as much attention, but is just as important, is how cancer treatments can affect a patient’s sexual health and reproductive future.

Many cancer patients, particularly younger ones, are often left in the dark about how their treatment could impact their sexual function and fertility. This gap in communication isn’t because doctors don’t care. Studies have shown that most oncologists believe addressing sexual function is a key responsibility. However, barriers such as time constraints, lack of training, and limited knowledge often get in the way of these critical conversations.

Why does this matter? Because cancer isn’t just a physical battle — it affects every aspect of a person’s life, including intimacy, relationships, and the dream of starting or growing a family. As I wrote in a commentary in the April issue of The Lancet Oncology, with cancers like colorectal cancer on the rise among young adults, it’s more important than ever to shine a light on this often-overlooked topic.

The hidden side effects of cancer drugs

Two recent examples highlight the need for better awareness and guidance on sexual and reproductive health during cancer treatment.

For men, certain cancer treatments can lead to hypogonadism — a condition where testosterone levels drop, potentially causing sexual dysfunction. Despite early warnings from smaller studies, major clinical trials for lung cancer treatments like alectinib didn’t initially monitor this risk. It wasn’t until late 2024 that a retrospective study confirmed symptomatic hypogonadism in men taking this drug. Given that some trials included patients as young as 18, this was a missed opportunity to provide vital information to those who might want to preserve their fertility.

Women are not immune to these risks. Nirogacestat, a recently approved treatment for desmoid tumors, showed promise in clinical trials. However, a significant number of women experienced ovarian dysfunction, ranging from temporary amenorrhea to permanent menopause. While some women saw their symptoms resolve after stopping the medication, others did not. This is particularly concerning because desmoid tumors, while rare, have a high long-term survival rate. These women need guidance on preserving their fertility, which the current research does not yet fully address.

How can we do better?

The U.S. Food and Drug Administration (FDA) has guidelines that recommend monitoring reproductive toxicity in clinical trials, particularly when animal studies show potential risks. This guidance is a good start, but it needs to be more widely implemented. By incorporating routine sexual and reproductive health evaluations into cancer trials, we can provide patients with the information they need to make informed choices about their futures.

Cancer treatment is about more than survival. It’s about living well — physically, emotionally, and intimately. Addressing the full spectrum of side effects, including those affecting sexual and reproductive health, is not just a medical responsibility but a moral one. Let’s keep the conversation going so that individuals with cancer not only live longer but live better.

David J. Benjamin, MD, is a medical oncologist at the Hoag Family Cancer Institute. His practice and clinical research focus on genitourinary cancers, including prostate, bladder, kidney, and testicular cancer.

Hoag is a nonprofit, regional health care delivery network in Orange County, California, that treats more than 30,000 inpatients and 480,000 outpatients annually. Hoag consists of two acute-care hospitals – Hoag Hospital Newport Beach, which opened in 1952, and Hoag Hospital Irvine, which opened in 2010 – in addition to nine health centers and 13 urgent care centers.

Hoag has invested $261 million in programs and services to support the underserved community within the past five years, including areas like mental health, homelessness, transportation for seniors, education, and support for single mothers. Hoag is a designated Magnet® hospital by the American Nurses Credentialing Center (ANCC). Hoag offers a comprehensive blend of health care services that includes five institutes providing specialized services in the following areas: cancer, heart and vascular, neurosciences, women’s health, and orthopedics through Hoag’s affiliate, Hoag Orthopedic Institute, which consists of an orthopedic hospital and four ambulatory surgical centers.

In the 2020–2021 U.S. News & World Report Best Hospitals Rankings, Hoag is the highest-ranked hospital in Orange County, and the only OC hospital ranked in the top 10 in California. Visit www.hoag.org for more information.