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Testicular failure

Primary hypogonadism - male

Testicular failure occurs when the testicles cannot produce sperm or male hormones, such as testosterone.

Causes

Testicular failure is uncommon. Causes include:

The following can increase the risk of testicular failure:

  • Activities that cause constant, low-level injury to the scrotum, such as riding a motorcycle or bicycle
  • Frequent and heavy use of marijuana
  • Undescended testicles at birth

Symptoms

Symptoms depend on the age when testicular failure develops, either before or after puberty.

Symptoms may include:

  • Decrease in height
  • Enlarged breasts (gynecomastia)
  • Infertility
  • Loss of muscle mass
  • Lack of sex drive (libido)
  • Loss of armpit and pubic hair
  • Slow development or lack of secondary male sex characteristics (hair growth, scrotum enlargement, penis enlargement, voice changes)

Men may also notice they do not need to shave as often.

Exams and Tests

A physical exam may show:

  • Genitals that do not clearly look either male or female (usually found during infancy)
  • Abnormally small, firm testicles
  • Tumor or an abnormal mass in the testicle or the scrotum

Other tests may show low bone mineral density and fractures. Blood tests may show a low level of testosterone and high levels of prolactin, FSH, and LH.

Your health care provider may also order a semen analysis to examine the number of healthy sperm you are producing.

Sometimes, an ultrasound of the testes will be ordered.

Testicular failure and low testosterone level may be hard to diagnose in older men because testosterone level normally decreases slowly with age.

Treatment

Male hormone supplements may treat some forms of testicular failure. This treatment is called testosterone replacement therapy (TRT). TRT can be given as a gel, patch, injection, or implant.

Avoiding the medicine or activity that is causing the problem may bring testicle function back to normal.

Outlook (Prognosis)

Many forms of testicular failure cannot be reversed. TRT can help reverse symptoms, although it may not restore fertility.

Men who are having chemotherapy that can cause testicular failure should discuss freezing sperm samples before the starting treatment.

Possible Complications

Testicular failure that begins before puberty will stop normal body growth. It can prevent adult male characteristics (such as deep voice and beard) from developing. This can be treated with TRT.

Men who are on TRT need to be carefully monitored by a doctor. TRT may cause the following:

  • Enlarged prostate, leading to difficulty urinating
  • Blood clots
  • Changes in sleep and mood

When to Contact a Medical Professional

Call for an appointment with your provider if you have symptoms of testicular failure.

Also call your provider if you're on TRT and you think you're having side effects from the treatment.

Prevention

Avoid higher-risk activities if possible.

References

Allan CA, McLachlan RI. Androgen deficiency disorders. In: Jameson JL, De Groot LJ, de Kretser DM, et al, eds. Endocrinology: Adult and Pediatric. 7th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 139.

Morgentaler A, Zitzmann M, Traish AM, et al. Fundamental concepts regarding testosterone deficiency and treatment: international expert consensus resolutions. Mayo Clin Proc. 2016;91(7):881-896. PMID: 27313122 www.ncbi.nlm.nih.gov/pubmed/27313122.

US Food and Drug Administration. FDA drug safety communication: FDA cautions about using testosterone products for low testosterone due to aging; requires labeling change to inform of possible increased risk of heart attack and stroke with use. Updated January 16, 2016. www.fda.gov/Drugs/DrugSafety/ucm436259.htm. Accessed June 27, 2017.

  • Testicular anatomy - illustration

    The penis is the male organ of reproduction and also the organ of urinary excretion. The testes are a paired set of glands that produce sperm. The scrotum is the sac that houses the testes.

    Testicular anatomy

    illustration

  • Male reproductive anatomy - illustration

    The male reproductive structures include the penis, the scrotum, the seminal vesicles, and the prostate.

    Male reproductive anatomy

    illustration

  • Testicular anatomy - illustration

    The penis is the male organ of reproduction and also the organ of urinary excretion. The testes are a paired set of glands that produce sperm. The scrotum is the sac that houses the testes.

    Testicular anatomy

    illustration

  • Male reproductive anatomy - illustration

    The male reproductive structures include the penis, the scrotum, the seminal vesicles, and the prostate.

    Male reproductive anatomy

    illustration

 

Review Date: 5/7/2017

Reviewed By: Brent Wisse, MD, Associate Professor of Medicine, Division of Metabolism, Endocrinology & Nutrition, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team. Editorial update 08/09/2018.

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