What is the definition of Testicular Failure?

Testicular failure occurs when the testicles cannot produce sperm or male hormones, such as testosterone.

What are the alternative names for Testicular Failure?

Primary hypogonadism - male

What are the causes for Testicular Failure?

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
• Obesity
• 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

What are the symptoms for Testicular Failure?

Symptoms depend on the age when testicular failure develops, either before or after puberty.

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.

What are the current treatments for Testicular Failure?

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.

What is the outlook (prognosis) for Testicular Failure?

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.

What are the possible complications for Testicular Failure?

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

When should I contact a medical professional for Testicular Failure?

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.

How do I prevent Testicular Failure?

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; 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.