Undescended testicles in an infant

When my son was born he was perfect and on time. No problems except that his left testicle had not dropped. He is now almost six months old and it still has not moved. Our doctor says that if it is still there when he is one year old, he will require surgery to pull it into place, otherwise, he will not be able to have children. The doctor has also mentioned talking to a specialist about possible hormone therapy before he is a year old, but he doesn't know for sure if that is a possibility. Do you have any suggestions?

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Robert Steele

Robert W. Steele, MD, is a board certified pediatrician at St. John's Regional Health Center in Springfield, MO. He graduated from medical... Read more

Testicles originate in the abdomen while the fetus is developing. As the fetus grows, the testes descend into the scrotum. Male infants born at term should have both testicles descended. Preterm infants often do not have the testicles fully descended; however, they do so by the time the infant is at the age of when he would have normally been born.

Many males have what are called retractile testes. This is a benign condition in which the testes tend to lie high in the scrotum such that the scrotum may look empty especially when it is cold. Differentiating this condition from undescended testes is important and done by examination. The child is placed in a warm room and the doctor's examination is done with the child in a squatting position. The testes are then manually brought down into the normal position. This should not cause pain, and the testes then may go back to their original high position when let go.

If on examination, the testicle is felt to be simply retractile, nothing additional is needed to be done because there is no risk associated with it. If, on the other hand, it is not retractile or it is difficult to tell the difference, hormone therapy may help in the diagnosis. Since the 1931, the hormone, human chorionic gonadotropin (HCG) has been used for diagnosis and treatment of undescended testes. However, varying dosages have been used on children of varying ages for varying lengths of time. The result of all this is that it seems the use of HCG in boys with undescended testicles may work as poorly as one-third of the time. And in fact, up to 20 percent of those who do respond to HCG therapy may have the testicle ascend again requiring further therapy. However, HCG works quite well in children with retractile testes. Therefore, in cases where the physical examination is difficult, hormone therapy is often used to distinguish between retractile testes and true undescended testes.

Whether hormone therapy is right for your child depends upon the examination. If the "undescended" testicle is, in fact, only retractile, neither surgery nor hormone therapy is required. If the undescended testicle is truly undescended, hormone therapy may be a consideration but the results may be disappointing. If it is difficult to distinguish on examination whether the testicle is retractile or truly undescended, then HCG therapy may be a great option for your child because it may help distinguish between the two. In any case, my suggestion to you would be to get to the answer by a year of age. Because of the possible future risk of infertility and malignancy of the true undescended testicle, the American Academy of Pediatrics recommends surgical correction at one year of age. So, any hormone therapy should probably be attempted before then.

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