Testicular failure occurs when the testicles cannot produce sperm or male hormones, such as testosterone.
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, testicular cancer, testicular torsion, and varicocele
- Injury or trauma to the testicles
- Genetic diseases, such as Klinefelter syndrome or Prader-Willi syndrome
- 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 depend on the age when testicular failure develops, either before or after puberty.
Symptoms may include:
- Decrease in height
- Enlarged breasts (gynecomastia)
- 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.
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 (determines if the problem is primary or secondary).
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.
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 the 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 are on TRT need to be carefully monitored by a doctor. TRT may cause the following:
- Enlarged prostate, leading to difficulty urinating
- Blood clots
- Changes in sleep and mood
Call for an appointment with your provider if you have symptoms of testicular failure.
Also call your provider if you’re on TRT and you think you’re having side effects from the treatment.
Avoid higher-risk activities if possible.
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; 2016:chap 139.
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 www.ncbi.nlm.nih.gov/pubmed/27313122.
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/DrugSafety/ucm436259.htm. Updated February 26, 2018. Accessed May 20, 2019.