Introduction

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

Causes

Testicular failure is uncommon. Causes include:

• Certain drugs, including glucocorticoids, ketoconazole, and opioid pain medications
• Diseases that affect the testicle, including hemochromatosis, mumps, orchitis, and testicular cancer
• Diseases that affect the testicle, including mumps, orchitis, and testicular cancer
• Injury or trauma to the testicles
• Testicular torsion and varicocele

Risks

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

• 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.

Physical Examination & Investigations

A physical examination may show:

• Genitals that do not clearly look either male or female (usually found during infancy)
• Abnormally small, firm testicles
• Tumour 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. 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. When to Contact a doctor, call for an appointment with your doctor if you have symptoms of testicular failure.

Prevention

• Avoid higher-risk activities if possible.
• Early repair of undecended testis.
• Avoidance of Infections disease like mumps through vaccination.
• Avoidance of risky sexual behaviour.

References

1. Brent Wisse, MD, Associate Professor of Medicine, Division of Metabolism, Endocrinology & Nutrition, University of Washington School of Medicine.
2. Matsumoto AM, Bremner WJ. Testicular disorders. In: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM. Williams Textbook of Endocrinology. 12th ed. Philadelphia, PA: Elsevier Saunders; 2011:Chap 19.
3. MedlinePlus http://www.nlm.nih.gov/medlineplus/
4. Swerdloff RS, Wang C. The testis and male sexual function. In: Goldman L, Schafer AI, eds. Goldman’s Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2011: chap 242.