In this situation, the testes are abnormal, atrophic, or absent, and sperm production severely disturbed to absent. FSH levels tend to be elevated (hyper-gonadotropic) as the feedback loop is interrupted( Testicular failure). The condition is seen in 49-93% of men with azoospermia. Testicular failure includes the absence of failure production as well as low production and maturation arrest during the process of spermatogenesis.
Causes for testicular failure include congenital issues such as in certain genetic conditions (e.g. Klinefelter syndrome), some cases of cryptorchidism or Sertoli cell-only syndrome as well as acquired conditions by infection (orchitis), surgery (trauma, cancer), radiation, or other causes. Mast cells releasing inflammatory mediators appear to directly suppress sperm motility in a potentially reversible manner and maybe a common pathophysiological mechanism for many causes leading to inflammation
Generally, men with unexplained hyper-gonadotropic azoospermia need to undergo a chromosomal evaluation.