What Is An Undescended Testicle Causes Treatment?

An undescended testicle, medically known as cryptorchidism, is a condition where one or both testicles do not move into the scrotum before birth. This is the most common birth defect involving the male genitalia, affecting about 3% of full-term baby boys. In most cases, the testicle descends on its own within the first few months of life, but when it does not, medical treatment is needed to prevent long-term complications.

What Causes an Undescended Testicle?

During fetal development, testicles form inside the abdomen near the kidneys. As the baby grows, hormones guide the testicles down through the abdomen and into the scrotum. This usually happens in the last few months of pregnancy.

When this process is interrupted, the testicle stays somewhere along that path. It may remain in the abdomen, in the groin, or just above the scrotum. The exact reason this happens is not always clear.

Hormonal factors play a central role. The mother’s hormones and the baby’s own hormone production both influence testicular descent. Some research suggests genetics also matter — boys with a family history of undescended testicles have a higher chance of having the condition themselves.

Several risk factors increase the likelihood. Premature birth is the strongest one. Because the testicles descend late in pregnancy, babies born early simply have not had enough time for the process to complete. Low birth weight, being small for gestational age, and certain maternal conditions like diabetes also raise the risk.

How Is an Undescended Testicle Diagnosed?

Diagnosis usually happens shortly after birth. A pediatrician performs a physical exam and checks whether the testicles can be felt in the scrotum. If a testicle is not in the correct position, the doctor will try to feel for it in the groin area.

Some testicles are “retractile,” meaning they move back and forth between the scrotum and the groin due to a reflex. This is normal and does not require treatment. The testicle eventually settles permanently in the scrotum during puberty.

An ultrasound is sometimes used to locate a testicle that cannot be felt during a physical exam. However, ultrasound is not always reliable for finding testicles inside the abdomen. In some cases, a surgeon may need to look inside the abdomen with a small camera — a procedure called laparoscopy — to find it.

If both testicles are undescended and cannot be felt, additional testing may be ordered to check hormone levels. This helps determine whether the testicles are present but hidden, or whether there is a more complex hormonal disorder.

Why Does Treatment Matter?

Untreated undescended testicles carry real risks. The most serious is testicular cancer. Men who had an undescended testicle have a higher risk of developing testicular cancer compared to men who did not. The risk is highest when the testicle remains in the abdomen. Early surgery does not eliminate the risk entirely, but it makes the testicle easier to examine and allows for earlier detection of any problems.

Fertility is another major concern. The testicles need to be slightly cooler than body temperature to produce sperm properly. The scrotum provides this cooler environment. When a testicle stays inside the body, the higher temperature damages the sperm-producing cells over time.

Research shows that men with one undescended testicle have lower fertility rates than men without the condition. Men with both testicles affected have even higher risks. Surgery performed early — typically before age 18 months — gives the best chance for normal sperm production later in life.

Hernias are also more common in boys with undescended testicles. The same opening that allows the testicle to descend can remain open, allowing abdominal contents to push through and create a hernia.

Torsion, a painful twisting of the spermatic cord that cuts off blood flow, occurs more frequently in undescended testicles. This is a surgical emergency that can result in loss of the testicle if not treated quickly.

What Are the Treatment Options?

Observation is appropriate in the first few months. Many testicles descend on their own by 3 to 6 months of age. If the testicle has not descended by 6 months, spontaneous descent is unlikely, and treatment is recommended.

Surgery is the standard treatment. The procedure is called orchiopexy. The surgeon makes a small incision in the groin, locates the testicle, and gently moves it down into the scrotum. The testicle is then secured in place with dissolvable stitches so it cannot move back up.

Orchiopexy is typically performed between 6 and 18 months of age. It is an outpatient procedure, meaning the child goes home the same day. Most children recover fully within a week or two. The success rate is high — over 90% in most published series.

In rare cases where the testicle is severely abnormal or has no blood supply, the surgeon may recommend removing it. This is called orchiectomy. This decision is made during surgery when the testicle appears nonviable.

Hormone Therapy: What Does the Evidence Show?

Hormone therapy using human chorionic gonadotropin (hCG) or gonadotropin-releasing hormone (GnRH) has been tried as an alternative to surgery. The idea is that these hormones stimulate the testicle to move down on its own.

The evidence for hormone therapy is mixed. Some studies show modest success rates, while others show very low success rates. A review of multiple studies found that hormone therapy works in only a small percentage of cases, and the testicle often moves only partially down rather than all the way into the scrotum.

Hormone therapy is rarely used today as a primary treatment. Most pediatric urologists consider surgery the most reliable and effective option. Hormone therapy may have a limited role in select cases, but it is not a standard recommendation.

What Happens After Treatment?

After surgery, most boys do very well. The testicle typically grows normally and functions well. Regular checkups are important to monitor the position and size of the testicle as the child grows.

In some cases, the testicle may move back up after surgery. This is uncommon but possible. If it happens, a second surgery may be needed.

The testicle may also be smaller than the other one. This is more likely if surgery was delayed. The size difference does not usually cause functional problems, but it is worth monitoring.

Boys who had an undescended testicle should learn how to perform testicular self-exams and continue them into adulthood. This is especially important because the risk of testicular cancer, while reduced after surgery, remains higher than in the general population.

When Should Parents Seek Medical Advice?

Parents should bring up any concern about their son’s testicles at the first well-baby visit. If a testicle has not descended by 6 months of age, a referral to a pediatric urologist is the standard next step.

There is no benefit to waiting longer. Earlier treatment is associated with better outcomes for fertility and a lower risk of future complications. The current clinical guidance supports surgery between 6 and 18 months of age.

Parents should not attempt to push the testicle down manually. This does not work and can cause pain or injury. The condition requires professional medical evaluation.