DEAR DR. ROACH: I am an active male in my 70s and in good health. I exercise, eat healthy, and keep my weight down, and my blood work comes back perfect. I have a unique situation that I haven’t read about before and can’t find any information about.

I have a mass growing in my scrotum that has been there for many years, and upon examination, it feels like a third testicle. I don’t know what to do about it or if I should I even do anything about it. It is painless and causes no problems. Is this common? Should I see a doctor about this? If so, should I see a urologist or my primary care doctor? Are there any treatments for this problem? — D.F.

ANSWER: Scrotal masses are always important and should be evaluated by your doctor as soon as they are discovered. Although testicular cancer is not the most common cause of a scrotal mass, it does remain among the most common cancers in young men and increases in likelihood as men get older. It can grow and spread rapidly, and even though it remains highly curable (even at later stages), treatment is much easier when it is found early.

Since the mass you noted has been there for many years, cancer is unlikely. Varicoceles (abnormal dilated blood vessels that are similar to varicose veins) and hydroceles (fluid collections) are common scrotal masses. An inguinal hernia can present itself as a scrotal mass.

I recommend starting with your primary care doctor, who is likely to make a diagnosis by exam but may order an ultrasound or make a referral to a urologist if it isn’t clear.

DEAR DR. ROACH: My eGFR is 48, and my ACR is 130.1 mg/g. I have asked my doctor for a referral to a nephrologist. My doctor has not responded. What do you advise? — P.G.

ANSWER: First, let’s explain what these are and what they mean. The estimated glomerular filtration rate (eGFR) is the standard expression of overall kidney function. Ninety or greater is normal, while 48 is in the mildly to moderately decreased range — or what’s called chronic kidney disease stage 3a.

The ACR is the albumin-to-creatinine ratio. Yours is in the moderately increased range, sometimes called A2, indicating that there is significant but not extreme loss of protein through the urine.

An online estimate of your risk of kidney failure in the next five years is 2.6% (available at CKDPCRisk.org/KidneyFailureRisk/). A review of recommendations from expert groups finds that this combination of results does not meet the absolute requirements for a referral to a nephrologist. However, it may still be reasonable to consider a referral.

I don’t know why your kidneys are not doing well. In my practice, by far the most common reason is kidney disease that is associated with diabetes. If this were the case, your doctor should be sure that your blood pressure is well-controlled, at least less than 130/80 mm Hg on average.

They should also consider an ACE inhibitor or an angiotensin receptor blocker even if your blood pressure is at or near these goals; this could cut your risk to 1.8%. An SGLT2 inhibitor by itself cuts the risk of your progressing to kidney disease by almost half, to 1.4%. In people with Type 2 diabetes, finerenone can also decrease the risk of progressing to kidney failure.

If your doctor is treating you appropriately with medications and recommending lifestyle changes to reduce your risk, a referral may not be necessary. Personally, I think it’s wise to have an expert who makes sure that my patients are being optimally cared for. It’s good to have them there in case renal replacement therapy is necessary.

If you haven’t discussed these options, or if your doctor hasn’t explained why your kidneys aren’t working perfectly, I recommend a consultation with a nephrologist.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu. (c) 2025 North America Syndicate Inc. All Rights Reserved