Undescended Testicle: Causes, Symptoms, and Treatment

What Is an Undescended Testicle?

An undescended testicle (cryptorchidism) is a condition in which one or both testicles do not descend from the abdomen into the scrotum before birth. During fetal development, the testicles normally form near the kidneys and gradually descend through a passage called the inguinal canal into the scrotum during the last few months of pregnancy.

However, in some cases—especially among premature or low-birth-weight infants—this descent may remain incomplete. The testicle may stay in the abdomen, groin, or a higher position in the scrotum.

This condition is one of the most common congenital anomalies in male infants, affecting nearly 3% of full-term and up to 30% of premature male infants. In most cases, the testicle descends naturally within the first six months of life, but persistent cases require medical intervention.

Types of Undescended Testicles

Understanding the different types helps in identifying appropriate treatment strategies:

• True Undescended Testicle: The testicle halts along the normal descent path, typically within the abdomen or inguinal canal.
• Ectopic Testicle: The testicle deviates from the normal path and may be located in an unusual area, such as the thigh, perineum, or pubic region.
• Retractile Testicle: The testicle moves between the scrotum and groin because of a strong cremasteric reflex. It typically does not need surgery but should be monitored during growth.
• Ascending (Acquired) Testicle: A testicle that was previously in the scrotum moves back up into the groin over time, often due to insufficient spermatic cord length or scarring.

Each type varies in presentation and treatment approach, so accurate diagnosis is essential for effective management.

Undescended Testicle Causes & Risk Factors

According to research cited by the National Institutes of Health (NIH), the exact cause of cryptorchidism is not fully understood. Still, several genetic, hormonal, and environmental factors may contribute to disrupted testicular descent.

Common causes and risk factors include:

• Premature birth: The process of descent usually happens late in pregnancy; premature infants often experience incomplete descent.
• Low birth weight or growth restriction: Infants who are smaller than average are more likely to be affected.
• Hormonal imbalance: Insufficient production of androgens (male hormones) or poor response to them can affect descent.
• Genetic abnormalities: Certain chromosomal disorders, such as Down syndrome or Prader-Willi syndrome, are associated with a higher risk.
• Maternal factors: Conditions like diabetes, obesity, or smoking during pregnancy increase risk.
• Environmental exposure: Endocrine-disrupting chemicals, such as pesticides or phthalates, may influence fetal hormonal development.
• Family history: A close relative with undescended testicles or other genital issues raises the risk in newborns.

How Undescended Testicles Affect the Body

An undescended testicle can impact a boy’s reproductive and hormonal health. Testicles function best at a temperature slightly lower than the body’s core temperature, which is essential for normal sperm production. When a testicle remains inside the abdomen or groin, it is exposed to higher temperatures that can damage the germ cells responsible for sperm production.

Over time, this may reduce fertility, particularly if both testicles are affected and remain undescended. Undescended testicles are associated with a higher lifetime risk of testicular cancer, even after corrective surgery, though early treatment significantly lowers the risk.

The condition may also cause mild discomfort or emotional distress related to appearance during later childhood or puberty.

Undescended Testes Symptoms

In infants, the condition is typically painless and is detected during routine physical examination.

Common symptoms include:

• Absence of one or both testicles in the scrotum
• Uneven or smaller scrotum on one side
• A lump or bulge in the groin area where the testicle may be trapped
• In older boys or men, there may be mild discomfort or a feeling of heaviness in the groin

Parents or doctors usually notice the absence of the testicle during the first newborn check-up or subsequent well-baby visits.

Complications if Left Untreated

If untreated, undescended testicles may lead to serious complications later in life:

• Infertility: Prolonged exposure to high body temperature damages sperm-producing cells.
• Testicular cancer: The risk is higher than in men with normally descended testicles, though the absolute risk remains low with early correction.
• Testicular torsion: The spermatic cord may twist, cutting off blood supply to the testicle.
• Inguinal hernia: The opening between the abdomen and groin may allow a loop of intestine to slip through.
• Psychological distress: Cosmetic concerns and anxiety can emerge during adolescence if the issue remains unresolved.

Prompt detection and treatment significantly lowers these risks.

Diagnosis of Undescended Testicles

Early diagnosis is critical to prevent long-term complications.

Common diagnostic steps include:

1. Physical Examination: The paediatrician gently palpates the groin and scrotum to feel for the missing testicle.
2. Ultrasound Imaging: A non-invasive method used to detect testicles located in the inguinal canal or abdomen.
3. MRI or CT Scan: Advanced imaging is used if ultrasound results are inconclusive.
4. Diagnostic Laparoscopy: A minimally invasive surgical procedure that allows direct visualisation of the testicle inside the abdomen.
5. Hormone Testing: Assessing hormones such as LH, FSH, and testosterone helps evaluate testicular function and exclude other hormonal conditions.

Tests for Undescended Testicles

Accurate diagnosis often requires laboratory and imaging tests to confirm location and evaluate function.

Common tests include:

• Ultrasound – Scrotum/Inguinal Region to locate nonpalpable testicles
• MRI Abdomen and Pelvis for deep-seated or complex cases
• Hormonal Assays (LH, FSH, Testosterone) to assess testicular function
• Laparoscopic Examination for visual confirmation when imaging is inconclusive

Treatment Options

The goal of treatment is to bring the testicle into the scrotum early to support normal development, preserve fertility potential, and prevent complications. Treatment typically depends on the child’s age and the testicle’s location.

a. Hormone Therapy

In select cases, doctors may recommend hormone injections such as human chorionic gonadotropin (hCG) or gonadotropin-releasing hormone (GnRH) to stimulate testicular descent.

This approach is generally reserved for boys whose testicles are close to the scrotum. Although less commonly used today, hormone therapy may help in select mild cases or as preparation before surgery.

b. Surgical Treatment (Orchidopexy)

Orchidopexy is the primary treatment for most cases of an undescended testicle. During this surgery, the surgeon locates the undescended testicle, brings it down into the scrotum, and secures it in place.

This procedure is performed under general anaesthesia and has a high success rate, typically above 90%. It is best done between 6 months and 18 months of age to preserve fertility potential and minimise cancer risk.

In some cases where the testicle is absent or nonfunctional, removal (orchiectomy) may be recommended.

Post-Treatment Care & Follow-Up

Post-surgical recovery is typically smooth, but monitoring is essential to ensure proper healing and function.

Care measures include:

• Limiting vigorous physical activity for 2–3 weeks after surgery
• Regular follow-up appointments to check the position and growth of the testicle
• Monitoring for any signs of swelling, infection, or recurrence
• Teaching adolescents testicular self-examination to detect abnormalities early
• Hormone evaluation during puberty if growth issues persist

Regular check-ups help ensure long-term reproductive and hormonal health.

Preventive Measures

Although it cannot always be prevented, maintaining good maternal health and prenatal care may help reduce the risk:

• Maintaining optimal maternal health during pregnancy
• Avoiding smoking, alcohol, and exposure to harmful chemicals
• Managing diabetes or obesity effectively before and during pregnancy
• Ensuring regular prenatal check-ups for monitoring fetal development

Early screening after birth and timely pediatric consultations can help detect and treat the condition before complications arise.

Conclusion

An undescended testicle (cryptorchidism) is a treatable condition when identified and managed early. Prompt medical evaluation, followed by hormone therapy or surgical correction (orchidopexy), supports normal reproductive development and greatly reduces long-term risks such as infertility and testicular cancer.

At Metropolis Healthcare, we’re committed to supporting every step of your child’s health journey with advanced diagnostics and compassionate care. With a network offering 4000+ tests, from specialised hormone assays to comprehensive full-body checkups, our expert team ensures accurate results with quick turnaround times. Enjoy seamless convenience through home sample collection, available across 10,000+ touchpoints, and easy booking via website, call, app, or WhatsApp.

Early screening, accurate testing, and timely treatment can make a lasting difference, helping children achieve healthy growth and development.

FAQs About Undescended Testicles

What causes an undescended testicle?

It results from hormonal imbalances, genetic factors, or environmental influences that disrupt testicular descent during fetal development.

Can undescended testicles descend on their own?

In many infants, the testicle descends naturally within six months. If it doesn’t, medical evaluation and treatment are advised.

How serious is an undescended testicle?

Although not life-threatening, untreated cases can lead to infertility, testicular cancer, and hernias in adulthood.

How is an undescended testicle treated?

• Hormone therapy (hCG or GnRH)
• Surgical correction (orchidopexy) to move and secure the testicle in the scrotum

Can a man father children with undescended testicles?

Yes, especially if treatment occurs early. However, delayed treatment can impact sperm quality and fertility potential.

When should surgery be done for an undescended testicle?

Surgery is best performed between 6 and 18 months of age for optimal fertility outcomes and reduced risk of complications.

References

https://www.ncbi.nlm.nih.gov/books/NBK470270/

https://www.aafp.org/pubs/afp/issues/2023/1000/cryptorchidism.html

https://www.nhs.uk/conditions/undescended-testicles/

https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/undescended-testicles