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Eighty percent of male rectal cancer patients are sexually active at the time of diagnosis and many can expect long-term survival. Although situated outside the targeted volume the testes are exposed to scattered radiation during radiotherapy. In this review we analyse the current literatureproviding data on testicular radiation exposure during radiotherapy for rectal cancer and the consequences on spermatogenesis and androgen levels.One hundred and eighty-eight records were identified using the databases Medline, Cochrane and Embase. Ten original articlesproviding data on testicular radiation exposure, androgen levels or spermatogenesis in rectal cancer patients were included for qualitative synthesis.The testes are exposed to a mean radiation dose between 0.27 and 8.4 Gy during long course radiotherapy. Androgen levels of irradiated patients are significantly lower compared topretreatment levels or patients treated with surgery alone. Radiotherapy increases the risk to have a testosterone level below 8 nmol/l by 17-30%. No data were found on spermatogenesis in rectal cancer patients.The testicular exposure to scattered radiation during radiotherapy for rectal cancer renders permanent infertility likely. A decrease in post-treatment androgen levels and an increased risk for low testosterone levels were found. Androgen deficiency is associated with sexual dysfunction.