Wesley Warren Jr., known as the man with the 132-lb scrotum, has died, the Las Vegas Review-Journal reports.
Warren made international headlines in 2012 when he turned down celebrity doctor Mehmet Oz's offer of free medical care rather than give the TV physician exclusivity on his story.
He out put off surgery for another year out of fear of dying under the knife, the Review-Journal reports.
But he had the enlarged mass, known as scrotal elephantiasis or lymphedema, successfully removed in April 2013 at the Center for Reconstructive Urology at the University of California.
It's unknown of the procedure contributed in any way to his death.
Warren died Friday at the University Medical Center. Citing patient privacy, doctors would not say what killed him.
But an old roommate told the Review-Journal he suffered from diabetes, heart attacks, high blood pressure and asthma.
He was 49.