Testicular failure

Definition

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

See also:

• Hypogonadism
• Secondary hypogonadism

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 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.

Signs and tests

A physical exam may show:

• Genitals that do not clearly look either male or female (usually found during infancy)
• Abnormally small testicles
• Tumor or growth (group of cells) on or near the testicle

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

Testicular failure and low testosterone levels may be hard to diagnose in older men because testosterone levels normally fall 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 excess growth of the prostate gland and an abnormal increase in red blood cells.

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

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 that begins before puberty will stop normal body growth. It can prevent adult male characteristics (such as deep voice and beard) from developing.

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: 6/28/2011

Reviewed by: Ari S. Eckman, MD, Chief, Division of Endocrinology, Diabetes and Metabolism, Trinitas Regional Medical Center, Elizabeth, NJ. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.