Testicular failure occurs when the testicles cannot produce sperm or male hormones, such as testosterone.
Testicular failure is uncommon. Causes include:
- Certain medicines, including glucocorticoids, ketoconazole, chemotherapy, and opioid pain medicines
- Diseases that affect the testicle, including hemochromatosis, mumps, orchitis, testicular cancer, testicular torsion, and varicocele
Hemochromatosis is a condition in which there is too much iron in the body. It is also called iron overload.Read Article Now Book Mark Article
Mumps is a contagious disease that leads to painful swelling of the salivary glands. The salivary glands produce saliva, a liquid that moistens food...Read Article Now Book Mark Article
Orchitis is swelling (inflammation) of one or both of the testicles.Read Article Now Book Mark Article
Testicular cancer is cancer that starts in the testicles. The testicles are the male reproductive glands located in the scrotum.Read Article Now Book Mark Article
Testicular torsion is twisting of the spermatic cord, which supports the testes in the scrotum. When this occurs, blood supply is cut off to the tes...Read Article Now Book Mark Article
- Injury or trauma to the testicles
- Genetic diseases, such as Klinefelter syndrome or Prader-Willi syndrome
Klinefelter syndrome, also called 47,XXY, is a genetic condition that occurs in males when they have an extra X chromosome. This can cause problems ...Read Article Now Book Mark Article
- Other diseases, such as cystic fibrosis
The following can increase the risk of testicular failure:
Symptoms depend on the age when testicular failure develops, either before or after puberty.
Symptoms may include:
- Decrease in height
- Enlarged breasts (gynecomastia)
- 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, follicle-stimulating hormone (FSH), and luteinizing hormone (LH). These hormone levels determine if testicular failure primary or secondary (due to a pituitary gland problem).
A testosterone test measures the amount of the male hormone, testosterone, in the blood. Both men and women produce this hormone. The test described...Read Article Now Book Mark Article
The follicle stimulating hormone (FSH) blood test measures the level of FSH in blood. FSH is a hormone released by the pituitary gland, located on t...Read Article Now Book Mark Article
The LH blood test measures the amount of luteinizing hormone (LH) in blood. LH is a hormone released by the pituitary gland, located on the undersid...Read Article Now Book Mark Article
If your concern is fertility, your health care provider may also order a semen analysis to examine the number of healthy sperm you are producing.
Semen analysis measures the amount and quality of a man's semen and sperm. Semen is the thick, white fluid released during ejaculation that contains...Read Article Now Book Mark Article
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.
Testicular failure and low testosterone level also may be hard to diagnose in obese men. This is because obesity lowers a carrier molecule for testosterone called sex hormone binding globulin (SHBG). The free testosterone level in the blood is usually normal in obese men who do not have testicular failure.
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.
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 starting treatment.
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 take TRT need to be carefully monitored by their provider. TRT may cause the following:
- Enlarged prostate, leading to difficulty urinating
- Blood clots
- Changes in sleep and mood
- Changes in good cholesterol (HDL)
- Blood becomes too thick (polycythemia)
When to Contact a Medical Professional
Contact your provider for an appointment if you have symptoms of testicular failure.
Also, contact your provider if you're on TRT and you think you're having side effects from the treatment.
Avoid higher-risk activities if possible.
Remain active and prevent weight gain as you get older.
Sandeep K. Dhaliwal, MD, board-certified in Diabetes, Endocrinology, and Metabolism, Springfield, VA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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 pubmed.ncbi.nlm.nih.gov/27313122/.
Schlegel PN. Clinical management of male infertility. In: Robertson RP, ed. DeGroot's Endocrinology. 8th ed. Philadelphia, PA: Elsevier; 2023:chap 113.
Swerdloff RS, Wang C. The testis and male hypogonadism, infertility, and sexual dysfunction. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 221.
US Food and Drug Administration website. 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. www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-cautions-about-using-testosterone-products-low-testosterone-due. Updated February 26, 2018. Accessed May 29, 2023.