When the testicle doesn't find its place
Undescended testicles (medically: maldescensus testis ) are a congenital developmental disorder in which one or both testicles are not fully located in the scrotum , but remain "stuck" in the inguinal canal or abdominal cavity.
This anomaly occurs in approximately 2-5% of all male newborns, and is significantly more common in premature infants. If it is not detected or treated, it can affect fertility, hormone production, and even the risk of cancer later in life.
Even though undescended testicles are usually corrected in early childhood, it is an issue that also affects adult men – for example, if it was detected late, was incompletely treated surgically, or leaves behind long-term consequences.
How does undescended testicles develop?
During embryonic development, the testicles migrate from the abdominal cavity through the inguinal canal into the scrotum. This process should be completed by birth.
If a testicle gets stuck on its way down – in the abdomen, inguinal canal, or at an unusual location – it is called undescended testicle. This is not just a positional anomaly, but a functionally relevant disorder, as the testicles are exposed to a higher body temperature outside the scrotum , which impairs sperm production.
What forms are there?
- Undescended testicle : Most common form, testicle lies in the inguinal canal
- Abdominal testicle : Testicle remains in the abdomen
- Gliding testicle : Testicle reaches the scrotum but retracts again
- Ectopic testicle : Testicle lies outside the typical descent path (e.g., thigh region)
- Retractile testicles (physiological) : Harmless in children, as the testicle temporarily slips back into the groin; no therapy is necessary.
It is important to distinguish between true undescended testicles and harmless retractile testicles , as the latter does not cause fertility problems.
Why is this relevant for men?
Untreated undescended testicles can have serious long-term consequences, even if they spontaneously regressed in childhood or were not noticeable at the time:
- Fertility problems : Testicles located outside the scrotum produce fewer sperm.
- Increased risk of testicular cancer : Especially in cases of undescended testicles or unilateral cryptorchidism.
- Hormone deficiency in adulthood : Impaired testosterone production
- Psychosocial stress : e.g., asymmetry or insecurity regarding physical closeness
- Impaired temperature regulation in the testicular area
Men in particular who have an unfulfilled desire to have children or have abnormal hormone levels should check their own childhood medical history - was undescended testicle diagnosed or treated at that time?
Symptoms in adulthood
Early undescended testicles can lead to the following problems in adulthood:
- Low testicular volume on one side
- Asymmetrical scrotum
- Reduced fertility (e.g., poor sperm quality in a sperm analysis)
- Reduced testosterone levels
- Loss of libido, drop in energy
- Gradual onset of hormonal exhaustion (“late-onset hypogonadism”)
- Possibly a palpable testicle outside the scrotum
How is undescended testicles diagnosed?
In children, the diagnosis is usually made directly after birth or in the first months of life by palpation.
In adults, a urological consultation is often necessary, in conjunction with:
- Ultrasound (sonography) for localization
- Hormone diagnostics : including testosterone, LH, FSH, SHBG
- Sperm analysis if there is an unfulfilled desire to have children
- Self-examination for lumps or volume differences
- If necessary, an MRI scan may be performed if the testicle cannot be located.
Such a check is particularly important in cases of unilateral testicular atrophy, or when there is no clear childhood documentation.
Therapy and long-term consequences
The standard treatment in childhood is surgical relocation of the testicle into the scrotum (orchidopexy), ideally before the first birthday. This significantly reduces the risk of later complications.
In adulthood, fewer therapeutic options are available; depending on the findings, the options include:
- Hormonal replacement therapy (e.g., in cases of testosterone deficiency)
- Sperm preservation (for couples wishing to have children)
- Removal (orchiectomy) in case of abnormal testicles or tumor risk
- Close long-term urological monitoring
Conclusion
Undescended testicles are not an issue that "ends with childhood." Even in adulthood, they can manifest in the form of hormonal imbalances, infertility, or an increased risk of testicular cancer , often going unnoticed for years.
Men with noticeable symptoms, hormonal imbalances or an asymmetrical scrotum should not hesitate to clarify the issue specifically - ideally first with their family doctor , who will refer them to a urologist or endocrinologist if necessary.
Tip: Use the premium hormone analysis from Adon Health You can discreetly and conveniently test your testosterone levels, LH, FSH, SHBG and other markers at home and then have them checked by a doctor.
