Treatment Overview

For parents receiving the diagnosis of an undescended testicle (cryptorchidism) in their baby boy, the first instinct is often to worry about long-term health and fertility. This condition occurs when one or both testicles do not fully drop into the scrotum, typically remaining in the abdomen or groin area. While the testicle may descend spontaneously within the first six months of life, intervention is necessary if it persists.

Treatment is critical because the optimal environment for sperm production is slightly cooler than body temperature. If the testicle remains inside the body, the higher temperature can permanently damage the cells responsible for future fertility. Furthermore, correction allows the testicle to be safely monitored for any potential malignant changes later in life. Treatment varies depending on the age of the patient and the testicle’s exact location (National Institute of Diabetes and Digestive and Kidney Diseases, 2023).

Overview of treatment options for Undescended Testicle

The main goal of intervention is to bring the testicle down into the scrotum as early as possible ideally before 18 months of age to maximize its development potential. The definitive treatment for an undescended testicle that has not spontaneously descended by six months is surgery (orchiopexy).

However, before surgery, or in certain selective cases, medication therapy using hormones is sometimes considered as a non-invasive option. While medication rarely succeeds if the testicle is far up in the abdomen, it may be attempted to promote descent when the testicle is close to the scrotum. Medications, while less effective than surgery, offer a chance to stimulate the natural physiological process before resorting to a procedure.

Medications used for Undescended Testicle

The drug class historically used to treat cryptorchidism is Hormone Therapy. These medications are designed to temporarily increase the levels of hormones necessary for stimulating testicular descent.

The primary example in this class is Human Chorionic Gonadotropin (hCG). This medication is given via a series of injections over several weeks. Another option, though less common in the United States, is Gonadotropin-Releasing Hormone (GnRH).

The success rate of hormone therapy varies widely but is generally low, especially compared to surgery. It is often only successful when the testicle is already near the scrotum. For this reason, many pediatric urologists today recommend skipping hormone therapy and moving straight to the surgical correction, which has a success rate of over 95% (American Urological Association, 2023).

How these medications work

Hormonal medications work by exploiting the body’s own reproductive pathways. Human Chorionic Gonadotropin (hCG) mimics Luteinizing Hormone (LH), a pituitary hormone. When hCG is injected, it signals the testicles to increase the production of testosterone.

This temporary surge in testosterone is designed to give the testicle the hormonal “push” it needs for the final stages of its descent into the scrotum. GnRH acts higher up the endocrine chain, stimulating the pituitary gland to release LH and Follicle-Stimulating Hormone (FSH), which then indirectly increases testosterone levels. The hope is that this hormonal stimulation will overcome whatever barrier is preventing the final descent, especially if the underlying cause is minor hormonal immaturity rather than a physical obstruction.

Side effects and safety considerations

Side effects from hormone therapy are generally temporary and related to the surge in reproductive hormones. With hCG injections, side effects may include local pain or irritation at the injection site.

More commonly, parents may observe temporary signs of puberty, such as slight growth of pubic hair, mild enlargement of the penis, or temporary swelling of the scrotum. These changes resolve after the course of treatment is finished. Treatment must be closely monitored by a pediatric specialist to ensure safety and track the testicle’s position. If the testicle descends after hormone therapy, regular check-ups are still necessary to ensure it remains in the scrotum and does not ascend back into the groin (Mayo Clinic, 2022).

Since everyone’s experience with the condition and its treatments can vary, working closely with a qualified healthcare provider helps ensure safe and effective care.

References

  1. American Urological Association. https://www.auanet.org
  2. Mayo Clinic. https://www.mayoclinic.org
  3. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov
  4. MedlinePlus. https://medlineplus.gov

Medications for Undescended Testicle

These are drugs that have been approved by the US Food and Drug Administration (FDA), meaning they have been determined to be safe and effective for use in Undescended Testicle.

Found 4 Approved Drugs for Undescended Testicle

Choriogonadotropin

Brand Names
Pregnyl, Ovidrel

Choriogonadotropin

Brand Names
Pregnyl, Ovidrel
Form: Injection, Kit
Method of administration: Subcutaneous
FDA approval date: October 06, 2003
Classification: Gonadotropin
Ovidrel ® PreFilled Syringe (choriogonadotropin alfa injection) is indicated for the induction of final follicular maturation and early luteinization in infertile women who have undergone pituitary desensitization and who have been appropriately pretreated with follicle stimulating hormones as part of an Assisted Reproductive Technology (ART) program such as in vitro fertilization and embryo transfer. Ovidrel ® PreFilled Syringe is also indicated for the induction of ovulation (OI) and pregnancy in anovulatory infertile patients in whom the cause of infertility is functional and not due to primary ovarian failure. Selection of Patients Before treatment with gonadotropins is instituted, a thorough gynecologic and endocrinologic evaluation must be performed. This should include an assessment of pelvic anatomy. Patients with tubal obstruction should receive Ovidrel ® PreFilled Syringe only if enrolled in an in vitro fertilization program. Primary ovarian failure should be excluded by the determination of gonadotropin levels. Appropriate evaluation should be performed to exclude pregnancy. Patients in later reproductive life have a greater predisposition to endometrial carcinoma as well as a higher incidence of anovulatory disorders. A thorough diagnostic evaluation should always be performed in patients who demonstrate abnormal uterine bleeding or other signs of endometrial abnormalities before starting FSH and Ovidrel ® PreFilled Syringe therapy. Evaluation of the partner's fertility potential should be included in the initial evaluation.

MethylTESTOSTERone

Brand Names
Estratest, Methitest

MethylTESTOSTERone

Brand Names
Estratest, Methitest
Form: Tablet, Capsule
Method of administration: Oral
FDA approval date: October 17, 1974
Classification: Androgen
ESTERIFIED ESTROGENS AND METHYLTESTOSTERONE FULL STRENGTH and ESTERIFIED ESTROGENS AND METHYLTESTOSTERONE HALF STRENGTH are indicated in the treatment of: Moderate to severe vasomotor symptoms associated with the menopause in those patients not improved by estrogens alone. (There is no evidence that estrogens are effective for nervous symptoms or depression without associated vasomotor symptoms, and they should not be used to treat such conditions.) ESTERIFIED ESTROGENS AND METHYLTESTOSTERONE FULL STRENGTH and ESTERIFIED ESTROGENS AND METHYLTESTOSTERONE HALF STRENGTH HAVE NOT BEEN SHOWN TO BE EFFECTIVE FOR ANY PURPOSE DURING PREGNANCY AND ITS USE MAY CAUSE SEVERE HARM TO THE FETUS (SEE BOXED WARNING ).

Xyosted

Generic Name
Enanthate

Xyosted

Generic Name
Enanthate
Form: Injection
Method of administration: Subcutaneous, Intramuscular
FDA approval date: September 18, 2012
Classification: Androgen
XYOSTED (testosterone enanthate) injection is an androgen indicated for testosterone replacement therapy in adult males for conditions associated with a deficiency or absence of endogenous testosterone. Primary hypogonadism (congenital or acquired): testicular failure due to cryptorchidism, bilateral torsion, orchitis, vanishing testis syndrome, orchiectomy, Klinefelter's syndrome, chemotherapy, or toxic damage from alcohol or heavy metals. These men usually have low serum testosterone concentrations and gonadotropins (follicle-stimulating hormone [FSH], luteinizing hormone [LH]) above the normal range. Hypogonadotropic hypogonadism (congenital or acquired): gonadotropin or luteinizing hormone-releasing hormone (LHRH) deficiency or pituitary-hypothalamic injury from tumors, trauma, or radiation. These men have low testosterone serum concentrations but have gonadotropins in the normal or low range. Limitations of Use: Safety and efficacy of XYOSTED in males less than 18 years old have not been established [see Use in Specific Populations.

Cypionate

Brand Names
Depo-Estradiol, Depo-Testosterone, Azmiro

Cypionate

Brand Names
Depo-Estradiol, Depo-Testosterone, Azmiro
Form: Injection, Kit
Method of administration: Intramuscular
FDA approval date: July 25, 1979
Classification: Androgen
Testosterone Cypionate Injection is indicated for replacement therapy in the male in conditions associated with symptoms of deficiency or absence of endogenous testosterone. Primary hypogonadism (congenital or acquired) - testicular failure due to cryptorchidism, bilateral torsion, orchitis, vanishing testis syndrome; or orchidectomy. Hypogonadotropic hypogonadism (congenital or acquired) - gonadotropin or LHRH deficiency, or pituitary-hypothalamic injury from tumors, trauma, or radiation. Safety and efficacy of Testosterone Cypionate Injection in men with “age­-related hypogonadism” (also referred to as “late-onset hypogonadism”) have not been established.
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