EpistemisTesticular atrophy
Specialty: Nephrology and urology.
Why it occurs
- Persistent high-grade varicocele (chronic venous stasis raises scrotal temperature and induces reflux of toxic adrenal metabolites that damage the germinal epithelium)
- Primary hypogonadism (congenital as in Klinefelter syndrome, or acquired from previous testicular torsion, severe trauma, or radiation therapy)
- Late sequel to urlian orchitis (mumps virus infection that causes tissue necrosis due to ischemia secondary to inextensible testicular inflammation within the tunica albuginea)
- Chronic consumption of exogenous anabolic steroids (negative feedback on the hypothalamic-pituitary-testis axis that suppresses the gonadotropins LH and FSH, resulting in atrophy of Leydig and germ cells)
- Liver cirrhosis or chronic alcoholism (altered estrogen metabolism with secondary hyperestrogenism)
Initial workup
Scrotal ultrasound with high-resolution color Doppler to accurately measure the testicle volumetrically (a volume <12-15 ml or length <3.5 cm is considered atrophic) and evaluate the echostructure of the parenchyma; complete blood hormonal profile (total testosterone, free testosterone, LH, FSH, estradiol, prolactin and sex hormone binding globulin - SHBG); semen analysis (seminogram or spermiogram) to evaluate the impact on spermatogenesis.
red flags
Rapidly progressive unilateral testicular atrophy accompanied by the appearance of a firm, stony, painless mass in the contralateral testicle (suggestive of contralateral germ cell tumor with cross-hormonal suppression), or sudden loss of secondary sexual characteristics in a young male.
Standard management
- Testosterone undecanoate — 1000 mg deep intramuscularly every 10-14 weeks; indicated only if persistent clinical and laboratory hypogonadism is confirmed, and active prostate cancer has been ruled out by PSA and digital rectal examination; keep in mind that exogenous testosterone does not restore testicular size and may exacerbate atrophy by further suppressing LH/FSH
- Human chorionic gonadotropin - hCG — 1000-2000 IU subcutaneously 2-3 times per week, used to directly stimulate Leydig cells and promote testicular growth and spermatogenesis in patients with hypogonadotropic hypogonadism desiring fertility
- Immediate cessation of the consumption of exogenous anabolic steroids.
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Nephrology and urology
- Listed causes
- 5
- Treatment options
- 3