Testicular failure

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Overview

The testis has an endocrine as well as an exocrine function. Endocrine testicular failure results in testosterone deficiency. In primary endocrine testicular failure, a decline in testosterone secretion (resulting in a condition termed hypoandrogenism) is caused by a deficiency or absence of Leydig cell function. Clinically relevant diseases described in this chapter are anorchia, Leydig cell hypoplasia and numerical chromosome abnormalities. Testicular dysgenesis is another cause for primary testicular failure that is described in depth in Endotext.com, Pediatric Endocrinology, Chapter 7: Sexual Differentiation. In contrast to primary endocrine testicular failure, secondary endocrine testicular failure is caused by absent or insufficient bioactivity of GnRH or LH (see Endotext.com, Endocrinology of Male Reproduction, Chapter 5: Hypogonadotropic hypogonadism and gonadotropin therapy).

The phenotype of primary exocrine testicular failure is male infertility. A comprehensive review on causes and treatment of male infertility is given in Endotext.com, Endocrinology of Male Reproduction, Chapter 7: Clinical management of male infertility. Cryptorchidism as a clinically relevant cause for primary exocrine testicular failure is discussed in Endotext.com, Endocrinology of Male Reproduction, Chapter 19: Cryptorchidism and hypospadias and testicular tumors as a cause and/or sequelae of testicular failure is discussed in Endotext.com, Endocrinology of Male Reproduction, Chapter 13: Testicular cancer pathogenesis, diagnosis and endocrine aspects.

This chapter focuses on anorchia, germ cell aplasia, spermatogenetic arrest, hypospermatogenesis, numerical chromosome abnormalities, structural chromosomal abnormalities, as well as Y chromosome microdeletions causing primary exocrine testicular failure.

Symptoms

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)

Causes

Orchitis refers to inflammation of the testicles. Its main symptoms are pain and swelling in the testicles, but it can also cause nausea and fever. While the swelling can initially make your testicles look larger, orchitis can eventually lead to testicular atrophy.


There are two main types of orchitis:


Viral orchitis. This is usually caused by the mumps virus. Up to one-thirdTrusted Source of men who have the mumps after puberty develop orchitis. This often happens within four to seven days of getting the mumps.

Bacterial orchitis. This type of orchitis is often due to a sexually transmitted infection (STI), such as gonorrhea or chlamydia. In some cases, it’s caused by an infection in your urinary tract or from having a catheter or other medical instrument inserted into your penis.

Other causes

In addition to orchitis, several other things can cause testicular atrophy, including:


Age. While women go through menopause, some men go through a similar process known as andropause. This causes low testosterone levels, which can lead to testicular atrophy.

Varicoceles. A varicocele is like a varicose vein, but located near the testicles instead of the legs. Varicoceles typically affect the left testicle and can damage the sperm-producing tubes within the testicles. This can make the affected testicle smaller.

Testicular torsion. This happens when a testicle rotates and twists the spermatic cord, which carries blood to the scrotum. Reduced blood flow can cause pain and swelling in your testicles. If it’s not treated within a few hours, it can cause permanent testicular atrophy.

Testosterone replacement therapy (TRT). Some men undergoing TRT experience testicular atrophy. This is because TRT can stop the production of gonadotropin-releasing hormone (GnRH). Without GnRH, the pituitary gland stops making luteinizing hormone (LH). Without LH, the testicles stop secreting testosterone, leading to smaller testicles.

Anabolic steroid or estrogen use. Taking anabolic steroids or estrogen supplements can cause the same effect on hormones as TRT.

Alcohol use disorder. Alcohol can cause both low testosterone and testicular tissue damage, both of which can lead to testicular atrophy.

Risk factors

Klinefelter syndrome. This condition results from a congenital abnormality of the sex chromosomes, X and Y. ...

Undescended testicles. ...

Mumps orchitis. ...

Hemochromatosis. ...

Injury to the testicles. ...

Cancer treatment.

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Complications

The complications of untreated hypogonadism differ depending on when it develops — during fetal development, puberty or adulthood.

Complications might include:

Abnormal genitalia

Enlarged male breasts (gynecomastia)

Infertility

Erectile dysfunction

Osteoporosis

Poor self-image

Prevention

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.