There is still a debate on the choice of medical or surgical approach for the management of the undescended testis and on their efficacy in preventing long-term complications. HCG has long been used, with various schedules, in the treatment of cryptorchidism. A complete descent occurs in 14-59% of cases, with the highest percentages in older children and the lowest in intra-abdominal testes. The usefulness of intranasally administered LHRH is even more controversial and its potency seems inferior to HCG. In the last decades the surgical intervention has been recommended at progressively earlier ages. Our opinion is that the orchiopexy is inevitable, around age 2 years, if medical treatment has failed and the gonad is located intra-abdominally or high in the inguinal canal. In contrast, if the testis shows a partial response to medical treatment and is close to the scrotum, a second HCG course can be performed around age 4 years.