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Stuart Dawe-Long: Sertoli Cell Only Syndrome – Something Тhat Comes Up More Often Than You’d Think
Stuart Dawe-Long/LinkedIn
May 28, 2026, 15:19

Stuart Dawe-Long: Sertoli Cell Only Syndrome – Something Тhat Comes Up More Often Than You’d Think

Stuart Dawe-Long, Andrology Lead/Training Lead at Manchester University NHS Foundation Trust, shared a post on LinkedIn:

”Today I want to talk about something that comes up more often than you’d think in male fertility: Sertoli Cell Only Syndrome (also called germ cell aplasia or Del Castillo syndrome).

In simple terms, if we look at the seminiferous tubules under the microscope, we see Sertoli cells doing their supportive job… but zero germ cells. No spermatogonia, no sperm precursors at all. Just the ‘nurse’ cells. This leads to non-obstructive azoospermia — no sperm in the ejaculate because none are being produced.

Why does this matter so much?

Many of these men have otherwise normal lives, normal testosterone, and normal virilisation. They can look and feel completely healthy. But when it comes to building a family biologically, this is a significant roadblock. Early recognition prevents years of fruitless treatments and lets us focus on the right next steps.

Common causes / associations:

  • Genetic (Y-chromosome microdeletions in AZF regions)
  • History of chemotherapy, radiation, or toxin exposure
  • Severe infections (like mumps orchitis)
  • Trauma or vascular issues
  • Idiopathic (a lot of the time we never find a clear trigger)
  • Klinefelter syndrome

Hormone pattern is pretty characteristic:

  • FSH markedly elevated (often 2-3x normal or higher) because of low inhibin B feedback from the missing germ cells
  • LH and testosterone usually normal (Leydig cells are typically spared)
  • This isolated high FSH with azoospermia is a big red flag that prompts us to think about testicular failure patterns like SCOS.

On physical exam:

Testes are often smaller than average (frequently <15-18 ml) and can feel softer. But not always. The rest of the male exam is typically unremarkable.

Treatment realities:

Unfortunately, there’s no medication that reliably brings back germ cells in true SCOS. We focus on:

  • Micro-TESE: success rates are lower than in other forms of NOA, but focal areas of spermatogenesis can sometimes hide
  • If no sperm is found, options like donor sperm and adoption become important conversations
  • Hormone optimisation if needed, though most have decent T levels already

The emotional side of this diagnosis is real. This isn’t a reflection of their manhood or worth — it’s a specific cellular issue in a complex biological process. We’ve come a long way with assisted reproduction, and there are still paths forward.

This isn’t a full or in depth review. Just some useful information to share for anyone interested.

If you or someone you know is struggling with their fertility journey, please reach out to organisations that can help. You are not alone.”

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Fertility Fertility and Sterility Fertility News fertility research infertility IVF male infertility pregnancy reproductive health Reproductive Medicine Sertoli Cell Sertoli Cell Only Syndrome Stuart Dawe-Long Women’s Health
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