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Preservation of male reproductive potential represents a major challenge, particularly in boys exposed to gonadotoxic therapies before the onset of spermatogenesis. While sperm cryopreservation is an established fertility preservation strategy for postpubertal males, no clinically validated option currently exists for prepubertal boys. Male fertility depends on the establishment and lifelong maintenance of a finite spermatogonial stem cell (SSC) pool within a specialized somatic microenvironment. Although the prepubertal testis lacks active spermatogenesis, it already contains the SSC populations required for future fertility and these are vulnerable to cytotoxic injury. Clinical and histological evidence shows that chemotherapy and radiotherapy, including conditioning regimens for haematopoietic stem cell transplantation, can deplete SSCs even when exposure occurs in early childhood, with consequences that may become apparent only at puberty or later in adulthood. Testicular tissue cryopreservation (TTC) has emerged as the only potential fertility preservation strategy for prepubertal boys at high risk of treatment-induced infertility. TTC aims to preserve immature testicular tissue containing SSCs for possible future use through experimental approaches. However, no human pregnancies have yet been achieved using tissue cryopreserved before puberty, and all current applications remain experimental. This review summarizes current practice for TTC in prepubertal boys, with a particular focus on the issues most relevant to paediatric endocrinologists involved in the long-term follow-up and management of these patients.<\/jats:p>","DOI":"10.1530\/ec-26-0146","type":"journal-article","created":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T10:42:01Z","timestamp":1779792121000},"update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-10","source":"Crossref","is-referenced-by-count":0,"title":["Fertility preservation in prepubertal boys: management and follow-up challenges"],"prefix":"10.1530","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6795-7347","authenticated-orcid":true,"given":"Vittorio","family":"Ferrari","sequence":"first","affiliation":[{"name":"1"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federico","family":"Baronio","sequence":"additional","affiliation":[{"name":"1"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcello","family":"Lanari","sequence":"additional","affiliation":[{"name":"1"},{"name":"2"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4650-3765","authenticated-orcid":true,"given":"Rod T","family":"Mitchell","sequence":"additional","affiliation":[{"name":"3"},{"name":"4"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"416","published-online":{"date-parts":[[2026,5,25]]},"reference":[{"key":"2026070714133075300_bib1","doi-asserted-by":"crossref","first-page":"1525","DOI":"10.1016\/S1470-2045(22)00637-4","article-title":"Long-term survival and cure fraction estimates for childhood cancer in Europe (EUROCARE-6): results from a population-based study","volume":"23","author":"Botta","year":"2022","journal-title":"Lancet Oncol"},{"key":"2026070714133075300_bib2","doi-asserted-by":"crossref","first-page":"1180","DOI":"10.1016\/j.fertnstert.2013.08.010","article-title":"Effects of chemotherapy and radiotherapy on spermatogenesis in humans","volume":"100","author":"Meistrich","year":"2013","journal-title":"Fertil Steril"},{"key":"2026070714133075300_bib3","first-page":"1391","article-title":"ESHRE good practice recommendations on fertility preservation involving testicular tissue cryopreservation in children receiving gonadotoxic therapies\u2020","volume":"40","author":"ESHRE FP for Boys Working Group","year":"2025","journal-title":"Hum Reprod"},{"key":"2026070714133075300_bib4","doi-asserted-by":"crossref","DOI":"10.1016\/j.mam.2024.101308","article-title":"Impacts of cancer therapy on male fertility: past and present","volume":"100","author":"Duffin","year":"2024","journal-title":"Mol Aspect Med"},{"key":"2026070714133075300_bib5","doi-asserted-by":"crossref","first-page":"1460","DOI":"10.1038\/leu.2017.76","article-title":"Decreased spermatogonial quantity in prepubertal boys with leukaemia treated with alkylating agents","volume":"31","author":"Poganitsch-Korhonen","year":"2017","journal-title":"Leukemia"},{"key":"2026070714133075300_bib6","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1093\/humrep\/dead004","article-title":"Childhood cancer and hematological disorders negatively affect spermatogonial quantity at diagnosis: a retrospective study of a male fertility preservation cohort","volume":"38","author":"Masliukaite","year":"2023","journal-title":"Hum Reprod"},{"key":"2026070714133075300_bib7","doi-asserted-by":"crossref","DOI":"10.1016\/j.bpobgyn.2025.102638","article-title":"Is the time right for transplanting immature testicular tissue or cells to restore male fertility? 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