What to do if a boy has no testicles

The absence of testicles in boys may be related to factors such as congenital anorchiosis, cryptorchidism, or trauma, and can be intervened through surgical treatment, hormone replacement therapy, etc. Testicular absence will affect the development of male secondary sex characteristics and reproductive function. It is recommended to seek medical evaluation as soon as possible.

1. Cryptorchidism

About 3% of full-term male infants have cryptorchidism, which is manifested by the failure of the testicles to descend into the scrotum. Abdominal cryptorchidism may be misdiagnosed as anorchidism and needs to be confirmed by ultrasound or laparoscopy. Cryptorchidism may increase the risk of testicular malignancy or impair reproductive function. Orchidopexy can be performed before the age of 2 years, and minimally invasive surgery using absorbable sutures is recommended. The medication optionally, human chorionic gonadotropin injection, attempts to promote testicular descent.

2. Congenital Anorchia

It is caused by the complete undevelopment of testicular tissue during the embryonic stage, so the probability of disease is low. The external genitalia of this type of child is childish, and there is no voice change or Adam's apple development during adolescence. Androgen replacement therapy needs to be started after the age of 12. Testosterone undecanoate capsules or testosterone patches are recommended. Bone age and hormone levels need to be monitored regularly to prevent premature epiphyseal closure from affecting height.

3. Necrosis after testicular torsion

Strenuous exercise or trauma may cause testicular torsion, and failure to perform surgical reduction within 6 hours may result in testicular ischemia and resection. Unilateral deletion does not affect fertility but the healthy side of the testicle needs to be protected. Varicocele may occur after trauma. Testicular prosthesis implantation can be considered to improve the appearance. Silicone medical implants are the preferred material for the prosthesis.

4. Endocrine abnormalities

Hypothalamic-pituitary lesions result in insufficient secretion of gonadotropins and may manifest as testicular dysplasia. In such cases, the primary disease needs to be treated first. For example, craniopharyngioma requires surgical resection, and then a combination of chorionic gonadotropin powder injection and urinary gonadotropin powder injection are used to promote testicular development. Testosterone and sperm quality need to be tested regularly during treatment.

5. Androgen insensitivity syndrome

She has chromosome 46XY but has a feminized vulva due to androgen receptor deficiency, and is often mistaken for being raised as a girl. If breast development is diagnosed during puberty but there is no menstruation, a psychological evaluation is required to decide whether to maintain female or male gender identity. Those who choose female identity need to remove intra-abdominal cryptorchidism to prevent malignant transformation, and use estradiol tablets to maintain female characteristics.

Daily care should be taken to avoid violent impact on the perineum, and prostate-specific antigen should be monitored for annual physical examination after puberty. It is recommended that parents record their children's growth and development curves. If secondary sexual characteristics such as pubic hair growth and thickening of the voice have not yet appeared by the age of 12, they should promptly seek medical treatment at a pediatric endocrinology department. Those with reproductive needs can be solved through testicular sperm extraction under a microscope combined with assisted reproductive technology when they reach adulthood.