While some variation in testicular size is normal, certain signs warrant immediate medical evaluation. Varicocele repair through surgery or embolization can improve testicular size and function in some cases. When testicular atrophy results from treatable conditions, addressing the root cause is essential. Men who wish to maintain fertility should discuss fertility-preserving options with their healthcare provider before starting any hormone therapy.
Another study found that a 500 IU dose of HCG every other day combined with a TRT protocol helped older men preserve testicular size, function, and sperm count. If you’re just starting your TRT protocol, taking HCG alongside Testosterone can help you avoid testicular shrinkage by encouraging continued Testosterone production from the start. The testes go dormant, which leads to potential testicular shrinkage and decreased fertility. To understand how HCG can prevent testicular shrinkage, we’ll explore the effect of exogenous Testosterone (Testosterone received from medication).
In addition, testicular atrophy can be recognized as greater than 50% loss of testicular volume or a post-operative testicle with less than 25% of the volume of the opposite testicle. Testicular volume measured to be less than 12 mL is a sign of testicular atrophy. A healthcare provider may initially assess size and shape as well as firmness and texture of the testicles. There is a possible correlation of cystic fibrosis and its impact to bilateral testicular atrophy. COVID-19 can lead to reduced testosterone production and testicular abnormalities due to changes in the secretion of gonadotropins, which are hormones involved in regulating testosterone production. Anabolic steroids and TRT are both used (either by prescription or illicitly) to mimic the effects of testosterone produced by the body, such as building muscle and maintaining sex drive. Excessive alcohol intake can cause inflammation and the degradation of cells in the liver, which can then cause testicular abnormalities (including testicular atrophy).
Poor diet can otherwise lead to oxidative stress, which causes sperm damage, leading to lower testicular volume and lower sperm quality. While immediate treatment can reduce the recovery time for the testes, there is still a chance of the testes to undergo atrophy a second time. Due to the high levels of oxidative stress in the semen, there may also be higher levels of sperm DNA fragmentation for people with varicoceles. Around 97-98% of people with cystic fibrosis who have testicles are infertile due to a missing vas deferens, the tube in the male reproductive system that carries sperm out of the testes. Testicular torsion is the twisting of the testicle within the scrotum and can rapidly result in damage due to interruption in blood flow to the affected testicle. Varicoceles are pooling of blood in the veins that deliver blood away from the testicles and are relatively common, occurring in approximately 15% of adolescent and adults with testicles.
Testicular atrophy refers to the shrinking of one or both testicles, where they become smaller than their normal size. Testicular shrinking (atrophy) can result from hormonal imbalances, steroid use, medical conditions, or aging, with low testosterone being a primary cause. Testicular atrophy is not merely a cosmetic side effect of testosterone therapy—it is a clear physiological indicator of systemic endocrine suppression. In my office, I can easily see that testosterone users have a predictable and substantial reduction in testicular mass—oftentimes to the size of small marbles. People who have testicular atrophy due to testicular torsion are immediately referred to surgery regardless of the ultrasound findings, since delays rapidly decrease the rate of recovery.
The consequences of not treating will result in decreased fertility and may result in the need of an orchiectomy, a surgical procedure to remove one or both testicles. Online calculators have been developed to estimate testicular volume based on sonographic measurements. Additionally, cystic fibrosis can result in the atrophy of male reproductive organs by causing dehydrated secretions. Evidence has shown that cystic fibrosis affects multiple systems in the human body, including the reproductive system. This might inform whether healthcare providers decide to monitor those who have survived COVID-19 for hormonal changes and potential fertility issues. Protein synthesis is highly important for the development and enlargement of muscle. Testosterone plays an important role in physiologically stimulating sex drive in people with testes.

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