Primary hypogonadism - male
Testicular failure occurs when the testicles cannot produce sperm or male hormones, such as testosterone.
Testicular failure is uncommon. Causes include:
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:
Men may also notice they do not need to shave as often.
A physical exam may show:
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).
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.
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:
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.
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.BACK TO TOP
Review Date: 5/12/2023
Reviewed By: 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.
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