Undescended Testis

An undescended testis means one or both testicles have not moved down into the scrotum as expected. It is also called cryptorchidism. This condition is usually identified in infancy, but many adults search for it because of fertility concerns, a history of childhood surgery, a missing testicle in the scrotum, or questions about cancer risk and hormone health. In men’s health, it matters because an undescended testis can affect sperm production, testicular development, and long-term reproductive outcomes if it is not evaluated and managed appropriately.

Table of Contents

1. What is undescended testis?
2. Key takeaways
3. Why it matters for health and fertility
4. Types and where the testis may be located
5. Causes and risk factors
6. Signs and symptoms
7. What’s normal vs what’s not?
8. How undescended testis is diagnosed
9. Treatment and timing
10. How it affects fertility, sperm, and hormones
11. Adult considerations
12. Undescended testis vs retractile testis
13. Questions to ask your doctor
14. Related tests and terms
15. Common myths and misconceptions
16. Frequently asked questions
17. References

What is undescended testis?

Undescended testis is a condition in which a testicle does not fully descend from the abdomen into the scrotum before birth or shortly afterward. Normally, the testes develop in the abdomen and move down into the scrotum late in pregnancy. When that process is incomplete, the testis may remain in the abdomen, in the groin, or partway along the normal path of descent.

The medical term is cryptorchidism. It can affect one testicle or both. According to major clinical guidance from the American Urological Association cryptorchidism guideline, spontaneous descent after about 6 months of age is unlikely, which is why timely follow-up matters.

At a glance:

• Usually diagnosed in infants and young children

• Can involve one or both testes

• May increase future risk of reduced fertility and testicular cancer

• Often treated with surgery called orchiopexy

• Deserves medical evaluation if the scrotum seems empty or one side feels different

Key takeaways

• Undescended testis means a testicle is not in the scrotum where it is expected to be.

• The condition is also called cryptorchidism.

• It is different from a retractile testis, which can move down into the scrotum and may not require surgery.

• Untreated undescended testes are linked with higher risks of impaired sperm production, subfertility, testicular torsion, inguinal hernia, and testicular cancer.

• Imaging is not usually the first step; careful physical examination is central to diagnosis, as emphasized by the AUA guideline.

• When treatment is needed, orchiopexy is usually recommended in early childhood.

• Adults with a history of undescended testis may still need assessment for fertility, hormones, and cancer surveillance awareness.

• A missing or high-riding testicle should be discussed with a clinician rather than watched indefinitely.

Why it matters for health and fertility

The scrotum keeps the testes slightly cooler than core body temperature. That cooler environment supports normal testicular development and sperm production. When a testis remains in the abdomen or groin, it may be exposed to higher temperatures for a prolonged period, which can impair the cells involved in future sperm production.

Undescended testis is important because it is associated with:

• Reduced fertility potential, especially if both testes are affected

• Higher risk of testicular cancer later in life compared with the general population, though the overall absolute risk remains relatively low

• Testicular torsion, where the spermatic cord twists and cuts off blood supply

• Inguinal hernia, which can occur alongside abnormal descent

• Psychological or body image concerns, particularly in adolescents and adults

Evidence reviewed in sources such as StatPearls on Cryptorchidism and guidance from the NHS supports the need for timely recognition and management.

Types and where the testis may be located

Not every undescended testis is the same. Doctors often classify it based on whether the testis can be felt and where it appears to be.

Palpable undescended testis

The testis can be felt on exam, usually in the groin or high scrotal area, but it is not sitting properly in the scrotum.

Nonpalpable undescended testis

The testis cannot be felt on exam. It may be:

• Inside the abdomen

• Very small or underdeveloped

• Absent due to prenatal loss or failed development

Ectopic testis

The testis has moved away from the usual path of descent and ends up in an abnormal location.

Acquired undescended testis

Sometimes a testis that was previously in the scrotum moves upward later in childhood and no longer stays in place. This is sometimes called an ascending testis.

Retractile testis

This is not the same thing as a true undescended testis. A retractile testis can be pulled upward by an active cremaster muscle but can usually be brought down into the scrotum during an exam and stay there briefly. It often only needs monitoring, though some retractile testes later become ascending testes.

Causes and risk factors

In many cases, there is no single clear cause. Testicular descent depends on coordinated hormonal signals, normal anatomy, nerve function, and fetal development. If one part of that process is disrupted, descent may not happen as expected.

Known or suspected contributors include:

• Premature birth — testes often descend late in pregnancy, so preterm babies have a higher risk

• Low birth weight or small size for gestational age

• Family history of undescended testes or certain genital development conditions

• Hormonal factors affecting fetal development

• Genetic or syndromic conditions in some cases

• Abdominal wall or groin abnormalities

Risk patterns are summarized by the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the Cleveland Clinic overview of undescended testicles.

It is worth noting that adult lifestyle factors do not cause a testis to become undescended in the classic congenital sense. However, an acquired ascending testis can be recognized later in childhood.

Signs and symptoms

In infants and children, the main sign is simple: one or both testicles are not present in the scrotum. The scrotum may look underdeveloped, asymmetrical, or emptier on one side.

Symptoms are often absent, but possible clues include:

• An empty or less full scrotum on one side

• A testicle that is felt in the groin but not in the scrotum

• A testis that seems to move up and not stay down

• Later fertility concerns in adulthood

• Occasional groin discomfort if associated with a hernia or torsion, though many cases are painless

Adults may discover the issue when evaluating:

• Low sperm count or infertility

• One-sided scrotal asymmetry

• A prior history of orchiopexy in childhood

• A nonpalpable or absent-feeling testicle

Acute pain requires urgent medical attention because torsion is a time-sensitive emergency.

What’s normal vs what’s not?

For readers trying to interpret what is expected, this is a helpful framework.

In newborns, spontaneous descent can still occur during the first few months of life. After about 6 months, spontaneous descent is much less likely, according to the AUA guideline.

How undescended testis is diagnosed

Diagnosis starts with a physical examination. A clinician checks whether the testicle can be felt, where it is located, whether it can be moved into the scrotum, and whether it stays there.

Common parts of evaluation

1. History — birth history, prematurity, prior surgery, and whether the testicle was ever seen in the scrotum

2. Physical exam — the most important first step

3. Referral to pediatric urology or urology if the diagnosis is uncertain or treatment is needed

4. Hormonal or genetic testing in select cases, especially if both testes are nonpalpable or there are concerns about differences in sex development

5. Surgical exploration or laparoscopy for some nonpalpable testes

Is ultrasound needed?

Many people assume ultrasound is always the next step. In fact, major guidance does not recommend routine ultrasound before specialist referral in typical cases because it often does not change management and may miss nonpalpable testes. This is specifically addressed by the American Urological Association.

Tests adults may need

Adults being evaluated for past or persistent undescended testis may need:

• Semen analysis

• Hormone testing such as testosterone, FSH, LH, and sometimes inhibin B

• Scrotal or groin exam by a urologist

• Imaging in select cases

Treatment and timing

Treatment depends on age, whether the testis is palpable, whether one or both sides are involved, and whether the condition is congenital or acquired. The standard treatment for a true undescended testis is orchiopexy, a surgery that moves the testicle into the scrotum and secures it there.

When is surgery usually done?

Guidelines generally recommend referral by 6 months of age if spontaneous descent has not occurred, with surgery typically performed between 6 and 18 months of age. Early treatment is intended to improve testicular development and make examination easier later in life. See the AUA cryptorchidism guideline and NHS guidance.

Treatment options

• Observation — appropriate only in early infancy when spontaneous descent may still occur, or in some retractile testes under follow-up

• Orchiopexy — the main treatment for true undescended testis

• Laparoscopy — often used for nonpalpable testes

• Orchiectomy — removal of the testis may be considered in some post-pubertal cases, especially if the testis is severely underdeveloped or cancer risk is a concern

What about hormone therapy?

Hormone treatment has been used in some settings, but it is not standard first-line care in many modern guidelines because success rates are variable and surgery is more reliable.

What orchiopexy does and does not do

• It places the testis where it can be examined more easily

• It may help preserve fertility potential, especially when done early

• It does not completely eliminate the increased cancer risk associated with an undescended testis, though earlier correction may reduce risk compared with delayed treatment

How it affects fertility, sperm, and hormones

This is the section many adult readers care about most. An undescended testis can affect sperm production because normal sperm development is temperature-sensitive. The longer a testis remains outside the scrotum, the greater the chance of damage to the germ cells that later produce sperm.

Potential fertility effects

• Unilateral undescended testis — fertility may still be normal in many men, especially if treated early, but risk is higher than in men without the condition

• Bilateral undescended testes — higher risk of reduced sperm counts, poor sperm quality, or infertility

• Delayed correction — may be associated with worse spermatogenic outcomes

Reviews such as Current Management of Undescended Testes discuss the relationship between timing of correction and later reproductive potential.

Can it affect testosterone?

Sometimes, but not always. The testes have two broad jobs: making sperm and producing testosterone. A history of undescended testis may impair sperm production more noticeably than testosterone production, especially when only one side is affected. Still, some men with bilateral disease or severe testicular dysfunction may have altered hormone levels.

How fertility is assessed in adults

1. Semen analysis to evaluate sperm count, motility, morphology, and volume

2. Hormone testing including testosterone, FSH, and LH if infertility or hypogonadism is suspected

3. Scrotal exam to assess testicular size and position

4. Ultrasound or further evaluation when indicated by a urologist

If you are trying to conceive and have a history of undescended testis, it is reasonable to bring that up early with a fertility specialist or urologist.

Adult considerations

Some men discover the issue in adulthood. Others had surgery as children and want to know what it means now. Adult management can differ from pediatric management because fertility goals, testicular size, cancer risk, and examination findings all matter.

Important adult questions

• Was the testis ever corrected surgically?

• Is the testis currently in the scrotum?

• Is it normal in size and texture?

• Are there fertility concerns?

• Is there any suspicious mass or change on exam?

Cancer risk

Undescended testis is associated with a higher risk of testicular germ cell tumor compared with the general population. Bringing the testis into the scrotum does not erase that risk, but it makes self-awareness and clinical examination easier. Reliable summaries are available from the StatPearls review and major urology guidance.

Self-awareness, not self-diagnosis

Men with a history of undescended testis should be familiar with the normal feel and size of their testes and report new lumps, swelling, heaviness, or persistent discomfort promptly. That is not a substitute for professional care, but it can support earlier evaluation.

Undescended testis vs retractile testis

These terms are often confused, but they are not the same.

If the distinction is unclear, a urologic exam is more useful than trying to interpret it alone.

Questions to ask your doctor

• Is this a true undescended testis, a retractile testis, or an ascending testis?

• Can the testicle be felt on exam, and where is it located?

• Do I or my child need referral to a urologist?

• Is surgery recommended, and if so, when?

• Will this affect fertility later on?

• Should semen analysis or hormone testing be done in adulthood?

• What is the long-term cancer risk, and what follow-up is appropriate?

• Could this be associated with a hernia or another condition?

Related tests and terms

• Cryptorchidism — the medical name for undescended testis

• Orchiopexy — surgery to move and fix the testis in the scrotum

• Retractile testis — a mobile testis that can move up temporarily

• Ascending testis — a testis that was once lower but later no longer stays in the scrotum

• Testicular torsion — twisting of the spermatic cord, a medical emergency

• Inguinal hernia — tissue protrudes through the groin area; may occur with undescended testis

• Semen analysis — laboratory test evaluating sperm count, motility, morphology, and related parameters

• FSH, LH, testosterone — hormone tests used in male reproductive evaluation

Common myths and misconceptions

Myth: It will always come down on its own eventually.

Not necessarily. Some testes descend during the first few months of life, but after about 6 months spontaneous descent becomes much less likely.

Myth: Ultrasound always gives the answer.

No. Physical examination and specialist evaluation are usually more important, and routine ultrasound is not always recommended before referral.

Myth: Surgery completely removes future cancer risk.

No. Surgery improves positioning and follow-up, but a history of undescended testis still carries some increased risk compared with men who never had the condition.

Myth: If one testicle is normal, fertility can never be affected.

Many men with one affected testis do remain fertile, but the risk of reduced fertility can still be higher than average.

Myth: Adults do not need to think about childhood undescended testis anymore.

Past history can still matter for fertility evaluation, testicular exam interpretation, and cancer awareness.

Frequently asked questions

Can an undescended testis cause infertility?

It can increase the risk, especially if both testes were undescended or treatment was delayed. The effect varies from person to person.

Is undescended testis the same as a retractile testicle?

No. A retractile testis can usually be moved into the scrotum and may stay there temporarily. A true undescended testis is not normally positioned in the scrotum.

At what age should an undescended testis be treated?

If the testis has not descended by around 6 months of age, referral is typically recommended, with surgery often performed between 6 and 18 months.

Can adults still have an undescended testis?

Yes. Some cases persist into adulthood, and some men only discover it later during fertility evaluation or self-exam.

Does orchiopexy improve fertility?

Early orchiopexy may improve fertility potential compared with delayed treatment, but outcomes depend on whether one or both testes were affected and how long the testis remained undescended.

Does an undescended testis always cause symptoms?

No. Many cases are painless. The main sign is usually that the testicle is not in the scrotum.

Can an undescended testis become cancerous?

It is associated with a higher risk of testicular cancer compared with the general population. That does not mean cancer will occur, but the history is clinically important.

Should I get a semen analysis if I had undescended testis as a child?

If you are trying to conceive, have concerns about fertility, or had bilateral disease, it is reasonable to discuss semen analysis with a doctor.

Can lifestyle changes bring the testis down naturally?

No lifestyle change, supplement, or exercise program has been shown to reposition a true undescended testis. If it is truly undescended, medical evaluation is needed.

References

• American Urological Association — Evaluation and Treatment of Cryptorchidism Guideline

• NHS — Undescended testicles

• StatPearls — Cryptorchidism

• Current Management of Undescended Testes — Review article available via PubMed Central

• NICHD — Cryptorchidism (Undescended Testes)

• Cleveland Clinic — Undescended Testicles