Testicular failure

• Alternative Names

  Primary hypogonadism - male

• Causes, incidence, and risk factors

  Testicular failure is uncommon. Causes include:

  • Certain drugs, including glucocorticoids, ketoconazole, and opioids
  • Chromosome problems
  • Diseases that affect the testicle, including mumps, orchitis, and testicular cancer
  • Injury to the testicles
  • Testicular torsion

  The following things increase the risk for testicular failure:

  • Activities that may cause constant, low-level injury to the scrotum, such as riding a motorcycle
  • Frequent and heavy use of marijuana
  • Undescended testicles at birth
• Symptoms
  • Decrease in height
  • Enlarged breasts (gynecomastia)
  • Infertility
  • Lack of muscle mass
  • Lack of sex drive (libido)
  • Loss of armpit and pubic hair
  • Slow development or absence of secondary male sex characteristics (growth and distribution of hair, scrotal enlargement, penis enlargement, voice changes)

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

• Signs and tests

  A physical examination may reveal:

  • Genitals that do not clearly look either male or female (usually noted in infancy)
  • Abnormally small testicle
  • Tumor or mass (group of cells) on or near the testicle

  Further testing may show decreased bone mineral density and fractures. Blood tests may reveal low levels of testosterone and high levels of prolactin, FSH, and LH.

  Testicular failure and low testosterone levels may be difficult to diagnose in older men because testosterone levels normally fall with age. The level of testosterone at which replacement therapy would be likely to improve symptoms and other outcomes is unpredictable and variable.

• Treatment

  Male hormone supplements may successfully treat some forms of testicular failure. Men who take testosterone replacement therapy need to be carefully monitored by a doctor. Testosterone may cause overgrowth of the prostate gland and an abnormal increase in red blood cells.

  Avoiding a specific drug or activity known to cause the problem may result in return of normal testicular function.

• Expectations (prognosis)

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

• Complications

  Testicular failure before the onset of puberty will stop normal body growth, specifically the development of adult male characteristics.

• Calling your health care provider

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

• Prevention

  Avoid higher-risk activities if possible.

• References

  Bhasin S. Testicular disorders. In: Kronenberg HM, Shlomo M, Polonsky KS, Larsen PR, eds. Williams Textbook of Endocrinology. 11th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 18.

  Bhasin S, Cunningham GR, Hayes FJ, et al. Testosterone therapy in adult men with androgen deficiency syndromes: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2006 Jun;91(6):1995-2010.

Review Date: 6/22/2009

Reviewed By: Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; Louis S. Liou, MD, PhD, Assistant Professor of Urology, Department of Surgery, Boston University School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.