Positive urinary pregnancy test in men

Case: A male undergoing lab tests came out positive for Beta-HCG. What could be the cause of positive Beta-HCG in a male?

Discussion: A positive pregnancy test in a man is a red flag for testicular cancer.

β-hCG is not usually present in males. Its presence suggests a tumor that produces β-hCG, such as Choriocarcinoma, Embryonal carcinoma, and mixed germ cell tumors. Rarely, some seminomas can secrete β-hCG.

Further Testing should be done.

 1. Serum tumor markers:

 • β-hCG (already elevated)

 • Alpha-fetoprotein (AFP) — elevated in NSGCTs except for pure seminomas and choriocarcinomas

 • Lactate dehydrogenase (LDH) — correlates with tumor burden

 2. Testicular ultrasound:

 • First-line imaging to identify testicular masses

 3. Scrotal and physical examination:

 • Palpate for masses or asymmetry

 4. CT scan of chest, abdomen, and pelvis:

 • To evaluate for metastasis (especially lungs, liver, retroperitoneum)

 5. Urology or oncology referral:

 • For surgical exploration (radical inguinal orchiectomy is both diagnostic and therapeutic)

#oncology

#endocrinology

References:

1. Groza D, Duerr D, Schmid M, Boesch B. When cancer patients suddenly have a positive pregnancy test. BMJ Case Rep. 2017 Jul 1;2017:bcr2017220493. doi: 10.1136/bcr-2017-220493. PMID: 28668822; PMCID: PMC5535187.

2. Tsai JR, Chong IW, Hung JY, Tsai KB. Use of urine pregnancy test for rapid diagnosis of primary pulmonary choriocarcinoma in a man. Chest. 2002 Mar;121(3):996-8. doi: 10.1378/chest.121.3.996. PMID: 11888991.

3. Paramore L, Chetwood AS. Role of urinary pregnancy testing in the diagnosis of men with testicular cancer. Ann R Coll Surg Engl. 2025 Jan;107(1):73. doi: 10.1308/rcsann.2023.0029. Epub 2024 Apr 2. PMID: 38563075; PMCID: PMC11658873.