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Condition

Undescended testicle (adult)

Undescended testicle in adulthood explained: cancer risk, fertility impact, and treatment options — with sources, not guesswork.

Also known as: cryptorchidism, adult cryptorchidism, undescended testis

Symptoms5 listed
ICD-10Q53.9
TreatableYes
DE
Medically reviewed by Dr. Elif Yılmaz, MD, FECSM
Last reviewed 22 July 2026
✓ Clinician reviewed
Undescended testicle✓ Clinician-reviewed information
Key takeaways
  • An undescended testicle reaching adulthood without treatment is uncommon, since most cases either resolve in infancy or are surgically corrected in early childhood — adult presentation usually means a case was missed, care was not accessible earlier, or a testicle "re-ascended".
  • The two clinically significant risks — reduced fertility and an increased chance of testicular cancer — are both real, well-documented, and the main reasons adult cryptorchidism is taken seriously.
  • Testicular cancer risk is genuinely elevated, commonly cited as several times higher than in men with normally descended testicles, though the absolute lifetime risk remains low in real terms.
  • Treatment decisions in adults differ from childhood management — repositioning the testicle (orchiopexy) versus removing it (orchiectomy) both remain relevant, and the right choice depends on age, position, health, and fertility goals.
  • This is not a condition to be embarrassed about or to have missed — for many men, particularly those who grew up without easy access to paediatric care, this is simply a gap in earlier medical attention rather than any personal failing.

Overview

An undescended testicle is a testicle that never moved down into the scrotum before birth. Doctors call it cryptorchidism. It usually sits somewhere along its normal path down — often in the groin, sometimes higher in the belly. It is one of the most common conditions boys are born with. In most cases the testicle drops on its own within a few months, or is fixed by a small operation in early childhood.

Because it is usually caught and fixed early, finding one in an adult is uncommon. When it does happen, there are a few reasons. The most common is a missed check in infancy or childhood. This is more likely where routine baby exams were not available. A second reason is an earlier operation that did not fully work. A third is a testicle that was in place as a young child but slowly rose back up over time. None of these are an adult’s fault. This is almost always a gap in earlier care, not a personal failing.

Two things make this worth taking seriously. The first is fertility. A testicle sitting outside the cooler scrotum for years tends to make sperm less well, and this gets worse the longer it stays up. The risk is higher when both sides are affected, since a normal testicle on the other side can often make up for one that is not.

The second is cancer risk. Men with a history of an undescended testicle have a higher chance of testicular cancer. This is truer when it was never fixed, or fixed only after puberty. Studies put the increase anywhere from about two-fold to as much as ten-fold, depending on how high the testicle sits. The key point is the direction, not the exact number. The risk is real, it is higher for a higher, hidden testicle, and it is a good reason for proper checks. Even so, the actual lifetime risk stays modest, not close to certain.

Care in an adult differs from care in a child. In children, the aim is almost always to bring the testicle down, to protect fertility and lower cancer risk. In adults, especially after many years, that benefit is smaller. A testicle undescended into adulthood has often already lost some function. So removal is genuinely considered, alongside bringing it down where a testicle can then be watched more easily. There is no single right answer for everyone. That is exactly why this deserves a proper specialist visit rather than either worry or avoidance.

For many men, particularly those who grew up without easy access to paediatric care, this is simply a gap in earlier medical attention rather than any personal failing — and it is worth approaching from that starting point rather than one of embarrassment.

Types of undescended testicle (adult)

Unilateral
Only one testicle affected; generally carries a lower fertility risk than bilateral cases, since the other testicle can often substantially compensate.
Bilateral
Both testicles affected; associated with a considerably higher risk of infertility, and sometimes with low testosterone if both are significantly affected.
Palpable
Can be felt on physical examination, typically located in the inguinal canal (groin).
Non-palpable (intra-abdominal)
Cannot be felt on examination, located higher within the abdomen; generally associated with a higher relative cancer risk than lower-positioned testicles.
Ascending (acquired)
A testicle that was in a normal scrotal position earlier in childhood but gradually moved upward over time, sometimes not identified until later.
How common is it?
Cryptorchidism at birth affects roughly 1–4% of full-term boys, but the great majority resolve spontaneously or are surgically corrected before adulthood, making true adult-persisting cryptorchidism uncommon. Reliable large-scale prevalence data specifically for adult presentation is limited — most evidence comes from case series and clinical reviews rather than large population studies.
Source: ncbi.nlm.nih.gov

Symptoms

An empty or asymmetric-feeling scrotum, with one or both sides lacking a palpable testicle
A lump or fullness in the groin, in cases where the testicle sits in the inguinal canal
Difficulty conceiving with a partner, sometimes the first thing that prompts investigation in adulthood
In bilateral cases, symptoms of low testosterone, including reduced libido, fatigue, or reduced muscle mass
Often no symptoms at all beyond the physical absence of the testicle from the scrotum

Causes

Disruption of the normal hormonal and physical process that guides testicular descent during fetal development
Prematurity and low birth weight, both strongly associated with higher rates of cryptorchidism at birth
Small size for gestational age, or certain genetic or hormonal conditions affecting development
Missed diagnosis or follow-up in infancy or childhood, particularly without consistent access to routine paediatric examination
A prior orchiopexy that failed to keep the testicle in a stable scrotal position
An "ascending" testicle that moved upward again after appearing normally positioned earlier in childhood

Risk factors

Prematurity or low birth weight
Family history of cryptorchidism
Certain genetic conditions affecting testicular development
Twin pregnancy
Limited or inconsistent access to routine paediatric healthcare during infancy and childhood
A prior undescended testicle diagnosis without confirmed, successful long-term correction

How it is diagnosed

Diagnosis in adults starts with a physical examination to determine whether the testicle is palpable — felt in the groin — or non-palpable, suggesting a higher, intra-abdominal position. This distinction matters for both risk assessment and planning any intervention. Where the testicle cannot be felt, imaging — typically ultrasound, sometimes followed by MRI — is used to help locate it, though imaging has real limits in reliably finding a truly intra-abdominal testicle, and diagnostic laparoscopy is sometimes used to locate it definitively.

Hormone testing is relevant, particularly in bilateral cases or where low testosterone symptoms are a concern, and typically includes testosterone alongside FSH and LH. Where fertility is a goal, semen analysis is a standard part of assessment. If a mass is identified on or near the testicle, tumour marker blood tests (AFP, beta-hCG, LDH) are used alongside imaging, given the elevated cancer risk — a standard, appropriate part of thorough evaluation rather than an alarming escalation.

When to see a doctor
  • You notice an empty or asymmetric-feeling scrotum, at any age
  • You have a groin lump or fullness that could represent an undescended testicle
  • You know or suspect you had cryptorchidism as a child and are unsure whether it was ever properly treated
  • You and a partner are experiencing infertility and have not had a full physical examination and semen analysis
  • You notice any new lump, hardness, or change in an undescended or previously undescended testicle
Reducing your risk
  • Prompt evaluation of any newly noticed empty or asymmetric scrotum, groin lump, or fertility concern, rather than delaying out of uncertainty or embarrassment
  • For men aware of a childhood history whose outcome is unclear, a one-off adult check-up to confirm current status is a reasonable, low-effort step
  • Regular testicular self-examination remains relevant for any man with a history of cryptorchidism, given the elevated cancer risk, even after treatment

Common questions

Is it too late to do anything if I am an adult and just found out I have an undescended testicle?
No, it is not too late to be properly evaluated and to discuss options, even though the calculation around treatment differs from childhood. Both surgical repositioning and removal remain real, actively considered options in adulthood, and the right choice depends on your specific situation rather than a fixed rule that adult cases cannot be helped.
Why would a doctor consider removing the testicle instead of just repositioning it?
In adults, particularly where a testicle has been undescended for many years or is positioned high in the abdomen, the fertility benefit of repositioning is often more limited than in childhood, while the elevated cancer risk remains a consideration either way. Removal is sometimes recommended, particularly for high-risk or non-functional testicles, but this is an individual decision made with a specialist.
How much higher is my testicular cancer risk, really?
Research findings vary, with commonly cited figures ranging from roughly two-fold to as much as ten-fold increased relative risk, depending on how high the testicle sat and whether and when it was corrected. It is important to understand this as an elevated relative risk on a still relatively low absolute baseline — not a near-certainty of developing cancer — while taking it seriously enough to warrant proper evaluation.
Does correcting the undescended testicle as an adult reduce my cancer risk?
This is genuinely debated and appears to depend significantly on timing — correction after puberty does not appear to reduce cancer risk to the same degree that early childhood correction does. That said, bringing a testicle into the scrotum, where it can be more easily examined and monitored, has practical value for earlier detection even if it does not fully normalise the underlying risk.
Can I still father children if I have an undescended testicle as an adult?
It depends significantly on whether it is unilateral or bilateral, and on how long the testicle has been undescended. Unilateral cases carry a meaningfully lower infertility risk than bilateral, since the other testicle can often compensate. A full fertility assessment — including semen analysis — is the only way to know your specific situation rather than assuming from the statistics.
Will I need testosterone therapy if I have both testicles removed?
Yes, if both testicles are removed (or were already significantly non-functional), testosterone replacement therapy would generally be needed to address the resulting low testosterone, and this is a standard, well-managed part of care. This is a conversation to have with your specialist as part of any decision about bilateral removal.
Is having only one testicle a problem for general health or hormone levels?
Generally, no — a single healthy testicle is usually enough to maintain normal testosterone and reasonable fertility potential for most men, which is part of why unilateral cases are viewed less urgently than bilateral ones. This does not mean it is irrelevant, just that the consequences of a single affected testicle tend to be less significant than when both are involved.
Could this have been caught and treated when I was a child?
In many cases, yes, with routine newborn and childhood examinations, which is why paediatric guidelines emphasise early screening and treatment by around six months of age. If this was not caught for you, it typically reflects gaps in earlier access to paediatric healthcare, not anything you or your parents did wrong — and it is not a useful thing to feel guilty about now.
Does having had cryptorchidism as a child but successfully treated mean I am now completely fine?
Successful, timely treatment substantially reduces the risks, but research suggests a modestly elevated cancer risk and, in some men, some fertility impact can persist even after correction, particularly if treatment happened later than the ideal early window. This is why lifelong awareness — including regular self-examination — remains relevant even for treated cases.
Is it normal to feel embarrassed bringing this up with a doctor as an adult?
It is an understandable feeling, but specialists encounter adult cryptorchidism regularly and will not find it unusual or awkward to discuss. Being upfront about your history and concerns is the only way to get an accurate, individually tailored assessment, and it is a far better use of that discomfort than continuing to avoid the conversation.
What does surgery for adult cryptorchidism actually involve?
This depends on the chosen approach and the testicle’s position — orchiopexy involves surgically mobilising and securing the testicle in the scrotum, while orchiectomy involves removal, sometimes performed laparoscopically for higher, intra-abdominal testicles. Specific technique, anaesthesia, and recovery details vary by case and are best discussed with the operating surgeon.
If I have an "ascending" testicle, does that mean my earlier treatment failed?
Not necessarily in the sense of anyone having done something wrong — an ascending or acquired undescended testicle is a recognised, distinct pattern in the literature, and is not automatically evidence of a botched original correction. It is, however, a genuine finding worth proper evaluation in its own right.
Should my brothers or sons be checked if I had an undescended testicle?
Family history is a recognised, modest risk factor, so mentioning this history to family members with young sons, or during newborn care, is a reasonable and useful thing to do. This is not about creating alarm — it is about making sure routine newborn examination has the full relevant family context.
Does an undescended testicle hurt?
Not typically on its own — cryptorchidism itself is usually not painful, and pain in this context is more often related to a separate issue, such as testicular torsion (a medical emergency) or, less commonly, a growth. New or worsening pain in or around an undescended testicle warrants prompt medical attention rather than being assumed to be normal.
Can an undescended testicle just be left alone if it is not bothering me?
This is a legitimate question worth a direct, honest conversation with a specialist rather than a blanket answer, since "leaving it alone" still carries the ongoing cancer risk regardless of symptoms. Some men, particularly older men with significant other health conditions, may reasonably choose careful monitoring over surgery — but this should be an informed decision made with a doctor, not an assumption made alone.

Sources

  1. AUA. Evaluation and Treatment of Cryptorchidism Guideline (2025). https://www.auanet.org/guidelines-and-quality/guidelines/cryptorchidism-guideline
  2. StatPearls. Cryptorchidism. NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK470270/
  3. Pettersson A, et al. Age at surgery for undescended testicle and risk of testicular cancer. N Engl J Med. 2007;356:1835-41. https://www.nejm.org/doi/full/10.1056/NEJMoa067588
  4. Diagnosis and Management of the Undescended Testicle: A Modern Update. Curr Treat Options Pediatr. 2026. https://link.springer.com/article/10.1007/s40746-026-00365-9
  5. NHS. Undescended testicles. https://www.nhs.uk/conditions/undescended-testicles/