What should I do if I don't feel my 4-month-old baby's testicles?

What to Do If You Cannot Feel Your 4-Month-Old's Testicles

You should have your baby examined by their pediatrician immediately, and if both testicles are confirmed to be nonpalpable (cannot be felt), your baby needs urgent referral to a pediatric urologist or surgical specialist by 6 months of age to evaluate for undescended testicles (cryptorchidism) and rule out serious conditions. 1

Immediate Assessment Needed

At 4 months of age, this requires prompt evaluation because:

• Spontaneous testicular descent can occur in the first 6 months of life but is unlikely after 6 months (corrected for gestational age) 1, 2
• The testicles normally complete their descent into the scrotum between 25-30 weeks of gestation, so by 4 months they should be in the scrotum 2
• If testicles remain undescended beyond 6 months, surgical intervention will be needed between 6-18 months of age to preserve fertility and reduce cancer risk 2

Critical Red Flag: Bilateral Nonpalpable Testicles

If both testicles cannot be felt, this is a medical emergency requiring immediate specialist consultation 1:

• A baby with a male-appearing penis but bilateral nonpalpable testicles could actually be a genetic female (46 XX) with congenital adrenal hyperplasia, a life-threatening condition 1
• This condition can cause shock, dangerously low sodium, and high potassium levels if not diagnosed quickly 1
• Do not allow circumcision until this evaluation is complete 1

What Your Pediatrician Should Do

Your primary care provider should: 1

• Obtain your baby's gestational history - premature babies have much higher rates of undescended testicles (15-30% vs 1-3% in full-term infants) 1
• Perform a careful physical examination in a warm room with warm hands to distinguish between truly undescended testicles versus retractile testicles (which temporarily pull up but can be brought down)
• Not order ultrasound or other imaging - these studies rarely help with decision-making and should not delay referral 1

Referral Timeline

Referral to a pediatric urologist should occur by 6 months of corrected age if the testicles remain undescended 2:

• The American Urological Association guidelines emphasize that after 6 months, spontaneous descent is unlikely 1
• Surgery (orchidopexy) should be performed between 6-18 months of age, with 18 months being the absolute latest 2
• Delaying beyond this timeframe causes progressive damage to the testicles - by 15-18 months, boys begin losing germ cells needed for future fertility 2

Why Early Treatment Matters for Long-Term Health

Timely surgical correction significantly impacts your child's future 2:

• Fertility preservation: By age 8-11 years, approximately 40% of boys with bilateral undescended testicles who haven't had surgery have no germ cells left in their testicles 2
• Cancer risk reduction: Surgery before puberty reduces testicular cancer risk by 2-6 fold compared to surgery after puberty 2
• Success rates are excellent: Open surgical intervention succeeds in over 96% of cases with testicular atrophy occurring in less than 2% 2

Common Pitfalls to Avoid

• Do not wait and see - the window for spontaneous descent closes at 6 months 1, 2
• Do not request imaging studies yourself - they are not helpful and delay appropriate care 1
• Do not delay if your baby was premature - use corrected gestational age, not chronological age, for timing decisions 1

What Happens Next

If undescended testicles are confirmed, the pediatric urologist will: 2

• Determine if the testicles are palpable (can be felt) or nonpalpable
• For palpable testicles: perform scrotal or inguinal orchidopexy (surgery to bring the testicle down)
• For nonpalpable testicles: perform surgical exploration to locate the testicle and determine the best approach
• Provide counseling about lifelong surveillance needs and slightly increased risks of infertility and testicular cancer 2