EpistemisLoss of testicular turgor
Specialty: Nephrology and urology.
Why it occurs
- Primary or secondary hypogonadism (the cessation of the hormonal and exocrine function of the Leydig and Sertoli cells causes epithelial atrophy, decreased production of intratesticular seminal fluid and loss of the normal firm elastic consistency)
- Androgen deprivation therapy (antiandrogen drugs such as bicalutamide or GnRH analogues such as leuprolide, used for the treatment of advanced prostate cancer)
- Physiological aging and andropause (gradual hormonal decline and cellular senescence of the testicular stroma)
- Late sequelae of testicular torsion or severe trauma with transient ischemia (resulting in partial necrosis and replacement of the parenchyma by loose inelastic connective tissue)
- Large varicocele of long bilateral evolution (leading to ineffective tissue hypothermia and chronic hypoxia that irreversibly damages germinal and supporting cells)
Initial workup
Complete hormonal profile (total testosterone, free testosterone, LH, FSH, prolactin, estradiol and SHBG); detailed scrotal ultrasound with elastography (ultrasound technique that allows quantitative measurement of the elasticity and rigidity of testicular tissue); quantitative and qualitative semen analysis; transrectal prostate ultrasound.
red flags
Rapid loss of testicular consistency and size accompanied by complete and de novo loss of libido, refractory erectile dysfunction of sudden onset, or development of rapidly progressive bilateral gynecomastia in a young patient (requires ruling out pituitary, adrenal or testicular tumor pathology through hormonal analysis).
Standard management
- Testosterone undecanoate — 1000 mg deep IM every 10-14 weeks; indicated exclusively if underlying clinical-hormonal hypogonadism is demonstrated and PSA elevation or signs of prostatic neoplasia are not detected on digital rectal examination; explain that it restores libido and muscle strength but not the consistency or size of the testicles
- Clomiphene citrate — 25-50 mg orally daily or alternately, selective estrogen receptor modulator that stimulates the secretion of pituitary gonadotropins to promote the endogenous synthesis of testosterone in young men who wish to maintain their fertility
- Specific treatments of the underlying causes such as surgical varicocelectomy.
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