Hormone therapy for undescended testicle

hCG

Treatment for undescended testicles with human chorionic gonadotropin (hCG) stimulates the testicles to release testosterone. As a result, a boy's undescended testicle may complete its descent, at least temporarily.

Treatment with hCG also stimulates enlargement of the testicles and growth of blood vessels to the testicles.

HCG usually is injected into a muscle, such as in the buttocks, and may be given daily or weekly.

GnRH

GnRH stimulates the pituitary gland to produce luteinizing hormone (LH). In men, LH stimulates the production of testosterone. GnRH is sometimes also called luteinizing hormone-releasing hormone (LHRH).

In Europe, GnRH has been approved for and used in the treatment of undescended testicles for many years. Although GnRH has been approved for use in the United States for other conditions, it has not been specifically approved (labeled) for the treatment of undescended testicles. But because it is an approved medicine, a doctor can choose the unlabeled use of GnRH to treat undescended testicles.

Treatment with hormones may stimulate an undescended testicle to complete its descent, at least temporarily, into the scrotum or to descend to a position where it is easier to treat with surgery.

Less commonly, hCG is used in combination with GnRH. This combined hormone therapy has not been widely used, and few studies have been done to find out how well it works.

There is some evidence that hormone therapy with GnRH before surgery to correct an undescended testicle (orchiopexy) may improve fertility, but this treatment is still under investigation.¹ At this time, it is not a part of standard treatments for undescended testicles.

Hormone therapy alone stimulates the testicles to complete their descent into the scrotum in less than 20 out of 100 cases. Reascent occurs in about 15 out of 100 males who are treated.² If the testicle can be made to descend using hormone therapy, surgery may not be needed. Some testicles may descend only part of the way when a boy is treated with hormones. But this may still be helpful, because the testicle may descend to a position that is easier to treat with surgery. Testicles move back out of the scrotum (reascend) more often when the testicle was originally in a high position, such as in the inguinal canal or abdomen.

Treatment with hCG may cause side affects such as:

• Growth of the penis.
• Enlargement of the testicles.
• Darkening or increased pigmentation of the scrotum.
• Growth of pubic hair.

Normally, these conditions (called virilization) occur during puberty. They are normal responses to increased levels of testosterone in males. These side effects of hCG usually recede or fade away after treatment ends. In most cases, treatment with hCG does not last long enough for these side effects to appear.

Treatment with GnRH has few side effects and does not have the virilizing effects seen with hCG.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

Hormone treatment may need to be continued for weeks or months, depending on factors such as the age of the child and where the undescended testicle or testicles are in the body, as well as the timing and size of the dose given. When both testicles are undescended, a relatively high dose of hCG is given for a short period of time. When only one testicle is undescended, a smaller dose is given over a longer period of time.

In some boys, an undescended testicle will descend during puberty without needing hCG.

A doctor may try hCG shots to help decide whether surgery is needed. If the testicle does not descend—even temporarily—with hCG shots, it is not likely to do so on its own; and surgery may be needed.

A testicle may descend only part of the way when the boy is treated with hormones. But this may still be helpful, because the testicle may descend to a position that is easier to treat with surgery. HCG also stimulates enlargement of the testicles and growth of blood vessels to the testicles, and surgery may be easier when the testicle is larger and has an improved blood supply.

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Citations

1. Schwentner C, et al. (2005). Neoadjuvant gonadotropin-releasing hormone therapy before surgery may improve the fertility index in undescended testes: A prospective randomized trial. Journal of Urology, 173(3): 974–977.

2. Schneck FX, Bellinger MF (2007). Abnormalities of the testes and scrotum and their surgical management. In AJ Wein, ed., Campbell-Walsh Urology, 9th ed., vol. 4, pp. 3761–3798. Philadelphia: Saunders Elsevier.