Patient's question:
My son is 10 years old. He had a hernia when he was young, but it wasn't serious and he never had surgery. Recently, he had a check-up, and the doctor said his testicles were too small and underdeveloped. Could you please tell me how to confirm the diagnosis and whether it can be treated? Is it necessary to get checked immediately?Doctor's answer:
The testes are important organs in males, serving as the male gonads. They are located in the scrotum, with one on each side. After reaching adulthood, each testis is approximately 4–5 cm long, 3 cm wide, and about 2.5 cm thick, with a volume of 20–30 milliliters. The testes are internally divided into 200–300 lobules, each containing three to four seminiferous tubules, which are the sites of sperm production. The seminiferous tubules within each lobule merge to form the rete testis, from which 10–15 efferent ductules extend out of the testes, ultimately combining into a single efferent ductule that leads to the epididymis.The testes have two primary functions: one is to produce sperm, enabling male fertility, and the other is to secrete male hormones (androgens). These hormones act on the brain through the bloodstream, stimulating sexual desire and the development and maintenance of male secondary sexual characteristics. However, due to genetic disorders, nutritional factors, and other conditions, the size of the testes can vary from person to person. Some may be larger, while others may be smaller, but as long as they fall within the normal range, slight variations do not necessarily indicate the strength of sexual function or fertility. It is not advisable to judge sexual function or fertility solely based on testicular size—larger testes do not necessarily mean stronger sexual function, and smaller testes do not necessarily mean weaker sexual function.
However, there is a lower limit: if the testicular volume is less than 10 milliliters, it may indicate testicular hypoplasia or atrophy. In such cases, the impact on sperm production is significant. Testicular volumes smaller than 10 milliliters often result in azoospermia (no sperm in the semen), oligospermia (reduced sperm count), or extremely low sperm motility. If both testes are smaller than 6 milliliters, the interstitial cells, which produce male hormones, may also be affected. This not only impairs sperm production but can also disrupt the secretion of male hormones, thereby affecting sexual function.
The main causes of testicular hypoplasia include the following:
1. Endocrine disorders: Abnormalities in the endocrine system, such as hypogonadotropic hypogonadism (a condition where the body fails to produce adequate sex hormones) or pituitary microadenomas, can impair testicular development, leading to hypoplasia.
2. Genetic factors: Chromosomal abnormalities, such as Klinefelter syndrome (a condition characterized by small testes or underdeveloped seminiferous tubules), can cause testicular hypoplasia.
3. Anatomical factors: In some cases, testicular hypoplasia may result from impaired blood supply during embryonic development or torsion of the spermatic cord during testicular descent. These are anatomical causes.
4. Infectious factors: The most severe case is orchitis caused by mumps during childhood, which can lead to testicular developmental disorders.
5. Trauma or surgical trauma: Some individuals may experience testicular damage due to injuries or surgeries, either in childhood, during puberty, or adulthood, resulting in hypoplasia or atrophy.
These five factors are the primary causes of testicular hypoplasia.
When it comes to treatment, some cases of testicular hypoplasia may still have therapeutic significance if the age is not too advanced or the condition is not too severe. Traditional Chinese medicine (TCM) theory holds that the kidneys govern the storage of essence, reproduction, and development. By replenishing kidney essence and boosting kidney qi, TCM can offer certain benefits in treating testicular hypoplasia. However, timing is crucial. If the individual is already an adult, the treatment may have limited effectiveness.
This highlights the importance of early detection, early treatment, and prevention of such conditions. For example, if someone contracts mumps, prompt treatment can help control the infection. If testicular infertility is detected in childhood, parents should seek medical attention and work closely with doctors to address the physiological deficiency through treatment, which can still be meaningful. Therefore, it is essential not to delay treatment until adulthood, when the need for marriage and family arises. By then, it may be too late.
If your child is still young, it is crucial to seek treatment as soon as possible to avoid further delays and to ensure a better outcome. Wishing you a speedy recovery!