Introduction: The management of male infertility has undergone rapid changes with advancements in assisted reproductive techniques such as testicular sperm aspiration and microdissection, testicular sperm extraction (MicroTESE). However, testicular biopsy remains an important tool for diagnosing and managing male infertility, as well as assessing spermatogenesis levels. Aim: To examine the histological patterns of testicular biopsies in male patients with infertility. Materials and Methods: This cross-sectional study was conducted at the Department of Pathology, ESIC Super Specialty Hospital, Hyderabad, Telangana, India from May 2012 to May 2023. A total of 141 Tru-Cut biopsies from patients with male infertility were included based on predefined inclusion and exclusion criteria. Histopathologists labeled and reported the slides, noting the pattern of histopathology and level of spermatogenesis according to Johnson’s criteria. The data was analysed for percentages and mean values. Results: The majority of patients 43 (30.5%) exhibited normal histopathology, followed by Sertoli cell-only syndrome in 37 (26.24%) patients, and complete spermatogenic arrest in 14 (9.93%) patients. The least common pattern observed was incomplete spermatogenic arrest. Testicular atrophy was observed in 13 (9.22%) patients. Conclusion: This study highlights the importance of understanding the histological patterns observed in testicular biopsies, as it provides valuable insights to clinicians regarding the likelihood of obtaining spermatozoa for testicular sperm extraction in infertile males.