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Testicular failure

Primary hypogonadism - male

 

Testicular failure occurs when the testicles cannot produce sperm or male hormones.

Causes

 

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, and testicular cancer
  • Injury or trauma to the testicles
  • Testicular torsion and varicocele
  • Obesity
  • Other diseases, such as cystic fibrosis

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 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 doctor 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 levels normally decrease slowly with age.

 

Treatment

 

Male hormone supplements may treat some forms of testicular failure. Men who take testosterone replacement therapy need to be carefully monitored by a doctor. Testosterone may cause the following:

  • Excess growth of the prostate gland
  • Abnormal increase in red blood cells
  • Changes in blood cholesterol
  • Changes in sleep and mood

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. Hormone replacement therapy can help reverse symptoms, although it may not restore fertility.

 

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 testosterone therapy.

 

When to Contact a Medical Professional

 

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

 

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; 2015:chap 139.

Basaria S. Male hypogonadism. Lancet. 2014;383:1250-63. PMID: 24119423 www.ncbi.nlm.nih.gov/pubmed/24119423.

Graybill SD, Vigersky RA. Male hypogonadism. In: McDermott MT, ed. Endocrine Secrets. 6th ed. Philadelphia, PA: Elsevier Saunders; 2013:chap 44.

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            Review Date: 4/23/2015

            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, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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