Dear Dr. Roach: I am writing regarding my son, who at age 15 had surgery and removal of his left testicle due to a cyst that was growing. The cyst proved negative for cancer.
He is now 31 and has no energy, is depressed at times, has no resolve to complete tasks and considers himself a 鈥渇reak鈥� due to the surgery results and negative reactions from women he dates due to his disfiguration.
His doctor diagnosed him as having half of the normal testosterone level for a man his age. If he had the other testicle, would that increase his testosterone to normal? What about testosterone shots?
I also suggested prosthesis to normalize his appearance. Could you describe the surgery? He is leery of another surgery. A.G.
Removal of a testis (the male gonad, which makes sperm, two of which reside in the testicles) can have both physical and psychological effects on men.
Most often, the esthetic consequences are not obvious, but nonetheless still may have significant effects on self-image.
The physical effects of loss of a single testis usually are not great. Fertility and sexual function are preserved. The other testis generally compensates, making normal or nearly normal amounts of sperm and testosterone in the same way that, if a woman loses an ovary, the remaining ovary does the work of both.
However, your son has lower-than-expected testosterone levels. Because the range of normal is so large (350 to 1,200 in my lab), making the diagnosis of low testosterone needs to be done carefully, keeping in mind his age, as you mentioned.
I agree that the symptoms your son has could be low testosterone; however, the symptoms could be depression, and it鈥檚 entirely possible he has both. It鈥檚 worth discussing testosterone replacement, which can be done through the skin or by injection.
A saline prosthetic is inserted into the scrotum, usually through an incision in the groin. Testicular prostheses have been proven to improve feelings of satisfaction, self-esteem, physical attractiveness and positive feelings during sexual activity. These need to be balanced against the risks of infection, contraction and extrusion of the prosthetic (about 10 per cent have at least one complication).
Dr. Roach regrets he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected] or write him at P.O. Box 536475, Orlando, FL 32853-6475.
