Hypogonadism - Testicular Failure

Testicular failure, also known as primary hypogonadism, is an uncommon condition that is characterized by the inability of the testicles to produce sperm and the male hormone testosterone. The are many factors that have been postulated as causes of the condition, which give rise to a wide array of signs and symptoms.  These factors can sometimes make diagnosis as well as treatment of testicular failure a challenging problem.

Causes

Medications are one of the possible causes of testicular failure. Drugs such as glucocorticoids, ketoconazole, chemotherapy and opioids have the potential to cause the condition. Some health conditions associated with causing testicular failure, include hemochromatosis, mumps, orchitis, cystic fibrosis, testicular torsion, varicocele and cancer. Injury or trauma to the groin region is also implicated as a potential causative factor.

Additionally, there are also several other risk factors for testicular failure, which include:

• Frequent motorcycling or cycling, due to constant, low-level scrotal injury.
• Heavy use of marijuana
• Undescended testicles at birth

Where applicable, risk factors should be minimized or treated if possible to avoid developing testicular failure. Minimization and/ or treatment of risk factors and causes may sometimes help to reverse the condition and restore normal testicular function if caught early enough.

Symptoms

Symptoms that may affect men with testicular failure include:

• Short stature
• Gynecomastia (enlarged breast tissue)
• Reduced muscle mass
• Reduced libido
• Less facial and pubic hair
• Delayed or absence of secondary male sex characteristics (e.g. hair growth, genital enlargement, deepening of voice)
• Infertility

Some men may also suffer from emotional or psychological symptoms, such as depression or anxiety as a result of the condition.

Diagnosis

The diagnosis of testicular failure will usually involve a discussion of the reported symptoms, a physical examination and diagnostic tests to further investigate the condition. However, it can be difficult to diagnose in elderly men, because the levels of testosterone naturally decrease with age.

Physical signs that may be indicative of testicular failure may include small, firm testicles or the presence of a tumor or growth in the testicle or scrotal region.

A blood test to investigate the concentration of hormones in the body is usually required. In particular, a low level of testosterone, but high levels of prolactin, follicle-stimulating hormone (FSH) and luteinizing hormone (LH) is indicative of testicular failure.

Other tests may help to investigate bone mineral density or an ultrasound may be useful to visualize the testes. A semen examination may also be needed to assess the number of healthy sperm that is being produced.

Treatment

If there is a particular factor that is likely to have caused the condition in the first instance, this should be treated without delay as a first line therapy. This may include ceasing medications linked to testicular failure, managing associated conditions more effectively and avoiding the use of marijuana and activities such as cycling. In some cases, this may allow the testicle function to return to normal if the damage has not been extensive.

Testosterone replacement therapy is useful in the treatment of testicular failure for men whose testicular function has been irreversibly damaged. However, there are certain risks associated with this therapy and it is important that men receive adequate medical support and follow-up care. Risks of therapy include excessive prostate gland growth, increased red blood cells, abnormal cholesterol levels and changes in sleep patterns and mood.

It is also important for affected men to have access to a strong support network to deal with the emotional and psychological effects of testicular failure.

References

• https://www.nlm.nih.gov/medlineplus/ency/article/000395.htm
• http://www.nytimes.com/health/guides/disease/testicular-failure/overview.html
• http://www.myvmc.com/diseases/testosterone-deficiency-primary-hypogonadism-and-secondaryhypogonadotrophic-hypogonadism/
• http://www.omicsonline.com/open-access/primary-testicular-failure-an-overview-2376-0311-1000e105.php?aid=62554