Treatment for Atrophied Testicle
The treatment for an atrophied testicle depends on the underlying cause, with options ranging from testosterone replacement therapy for hypogonadism to surgical intervention such as orchiectomy or organ-preserving surgery in specific cases.
Diagnosis and Assessment
- Testicular ultrasound should be performed to confirm atrophy, assess the contralateral testis, and rule out underlying pathology such as testicular cancer 1
- Blood tests should include total testosterone, luteinizing hormone (LH), follicle-stimulating hormone (FSH), and tumor markers (AFP, β-HCG, LDH) if malignancy is suspected 1
- Testicular volume <12 ml is considered atrophic and warrants further evaluation 1
Treatment Options Based on Etiology
Primary Hypogonadism
- Testosterone replacement therapy is indicated for symptomatic hypogonadism due to testicular failure, including cases resulting from cryptorchidism, orchitis, or previous orchidectomy 2
- Testosterone cypionate injection is FDA-approved for replacement therapy in males with symptoms of testosterone deficiency 2
Cryptorchidism-Related Atrophy
- In adults with unilateral undescended testis and atrophy, orchidopexy may be offered to preserve androgen production and fertility potential 1
- If the contralateral testis is normal, orchiectomy may be considered due to the increased risk of testicular cancer in the undescended atrophic testis 1, 3
Post-Surgical or Post-Traumatic Atrophy
- Testicular atrophy following inguinal hernioplasty or testicular torsion is typically irreversible 4, 5
- Management focuses on preserving function of the remaining testicular tissue and hormone replacement if necessary 6
Atrophy with Testicular Intraepithelial Neoplasia (TIN)
- If TIN is diagnosed in an atrophic testis, treatment options include:
- Immediate definitive treatment
- Surveillance with delayed treatment
- No treatment 1
- If fertility is not a concern, radiotherapy with 16-20 Gy (2 Gy fractions, 5x/week) is recommended 1
- In patients with TIN and no gonadal tumor, orchiectomy is preferred over irradiation to avoid damage to the contralateral testis 1
Special Considerations
Fertility Preservation
- Sperm banking should be considered before any surgical intervention or radiotherapy that might affect fertility 1
- Even in men with azoospermia, significantly elevated FSH, and testicular atrophy, testicular biopsy may identify viable sperm in approximately 30% of cases for potential use in assisted reproductive techniques 7
Bilateral Atrophy
- In cases of bilateral testicular atrophy, organ-preserving surgery should be considered when possible 1
- Partial orchiectomy may be performed in specialized centers for patients with bilateral testicular tumors or tumor in a solitary testis with contralateral atrophic testis 1
Follow-up
- Regular monitoring of hormone levels and testicular volume is recommended 1
- Self-examination should be taught to patients with a history of testicular atrophy due to the increased risk of testicular cancer 1
- Long-term follow-up is necessary to monitor for late complications including hypogonadism and malignancy 1
Common Pitfalls
- Assuming all cases of testicular atrophy require surgical intervention; many cases can be managed conservatively or with hormone replacement 2
- Failing to consider fertility preservation before definitive treatment 1
- Overlooking the increased risk of testicular cancer in patients with atrophic testes, particularly those with a history of cryptorchidism 1, 3