Testicular atrophy is a medical term for what basically amounts to shrinking or shriveling testicles. Unusually small testicles aren’t usually included; the term is typically reserved for organs that start out healthy, then begin to wither and shrink without warning. A number of different things can cause this sort of atrophy, though hormonal imbalances and drug use are two of the most common. Old age, injury, and certain diseases may also be to blame. Men with this condition, however caused, are likely to experience a decreased sex drive and possibly also infertility. A lot depends on the extent of the damage as well as what caused it.
What Happens
Human testicles are made up primarily of two different cell types. Germ cells are responsible for producing sperm, while Leydig cells produce the male sex hormone testosterone. Men in good health typically produce both cell types in roughly equal amounts, and as a result their testes tend to be full, round, and firm. During atrophy, one or both of these cell types tend to die off. This causes a range of internal changes including fluctuation in fluid levels and semen chemistry, but is perhaps most noticeable on the outside: men with this condition tend to have visibly shrunken organs that are soft and loose to the touch.
How Is Testicular Atrophy Diagnosed?
If a doctor suspects that a patient is suffering from testicular atrophy, they will conduct an exam to observe the shape and size of the testicles. They will look for signs that the testicles have pulled back from the front wall of the scrotal sac, such as loose skin.
Following visual analysis, the doctor will check the testicles for firmness, as testicular atrophy typically causes the organ to soften as the cells die.
In some cases, they may order an ultrasound, which can reveal changes in testicular volume, as well as atypical blood flow.
The final step of diagnosis is typically blood, hormone, and STI panels to find the underlying cause of the testicular atrophy.
Hormone-Related Causes
There are many reasons why a man may experience this sort of atrophy, though in most cases it has to do with outside factors. Hormonal imbalance is one of the most common. Sometimes imbalances happen on their own, but more often they are a consequence or side effect of medicines or other treatments. Exposure to radiation, as is common in cancer treatments, is one possibility; taking pharmaceutical drugs that contain estrogen, testosterone, or other sex hormones is another.
Steroid may also be to blame. When a man takes steroids, which are basically chemical compounds designed to intensify muscle growth and strength, he is putting an outside source of testosterone into his body. This causes the body to think it has enough, which can cause it to produce less sperm or no sperm at all, both of which can lead to atrophy. Quitting steroids can usually reverse the shrinking, but not always. A lot depends on the timing and how much damage has been done.
Diseases and Other Ailments
Certain viral infections, including mumps or the Human Immunodeficiency Virus (HIV), are known to cause atrophy, along with a number of sexually transmitted diseases, particularly gonorrhea and syphilis. In most of these cases, the body is triggered by the infection to either shut down reproductive function or else attack the healthy tissues in the sex organs. Sometimes the damage can be undone when the underlying cause is treated, but not always.
A man who has suffered an injury to his groin or who has a disease or condition that impacts that region, like prostate cancer, might also experience shrinking as a side effect. If blood flow is interrupted to the testicles because of surgery or disease, atrophy is also somewhat common. Alcoholics are usually at an increased risk, particularly if their disease has caused either cirrhosis of the liver or kidney failure, as both of these conditions can negatively impact the testes.
Atrophy is sometimes simply a factor of old age. Men who are past their reproductive prime may experience shrinkage as a natural part of the body’s aging process. Medical professionals can often help men in this category enjoy robust sex lives, but regaining full and firm testicles isn’t always possible.
Can TRT Cause Testicular Atrophy? TRT, or testosterone replacement therapy, is a standard doctor-prescribed treatment for age-related testosterone loss and hypogonadism, in which your body does not produce enough testosterone. While TRT is typically safe when used as prescribed, it has been linked to increased risk for testicular atrophy. This occurs when the hypothalamus, a gland inside the
brainthat sends messages between the nervous and endocrine systems, stops producing gonadotropin-releasing hormone (GnRH). Once the body stops maintaining normal levels of GnRH, it ceases the production of luteinizing hormone, which triggers sperm and testosterone production. Over time, this process leads to the symptoms associated with testicular atrophy. Studies have shown that human chorionic gonadotropin (
hCG) can mitigate TRT-related testicular atrophy by mimicking LH in men. In turn, the testicles resume sperm and testosterone production, helping return volume and firmness to normal levels.
Side Effects and Consequences
Testicular atrophy has the potential to be very serious, but a lot of this depends on what is going on at the cellular level. If a man’s germ cells have been impacted, he may become infertile, and if the Leydig cells are affected, he may experience a loss in his sex drive, which can lead to erectile dysfunction. Patients may also experience a decrease in muscle and bone mass, weight gain, moodiness, and even hot flashes.
Does Testicular Atrophy Hurt?
While testicular atrophy is not a painful condition, the underlying cause may cause severe discomfort.
For example, testicular torsion is a condition where the vas deferens become twisted, blocking blood flow to one or both testicles. While the condition is quite rare, trauma to the scrotal sac is the most common cause. Once the vas deferens is twisted, the first symptom is sudden, extreme pain in the testicles.
It is considered a medical emergency, as patients are at risk of testicular tissue death without surgery. If not treated quickly, permanent damage to the testicular cells can cause permanent volume loss.
Some STIs, such as gonorrhea, chlamydia, and syphilis, can also cause testicular pain. As the condition worsens and the genital tissue becomes increasingly inflamed, it affects how efficiently blood can reach the testicles.
Treatment Options
Treating this sort of atrophy is usually more about identifying and curing the underlying condition than it is about addressing the shrinkage directly, as in most cases the two go hand in hand. Figuring out what’s going on can often be somewhat challenging, though. Healthcare providers usually start by looking at the patient’s lifestyle and health history, then run a series of tests to rule out more serious conditions.
Is Testicular Atrophy Reversible?
Reversing the effects of testicular atrophy depends on the underlying cause and how quickly a patient begins treatment.
When an infection is the source of atrophy, a course of antibiotics can destroy the bacteria, allowing the tissue to heal and testicular volume to return. hCG treatments have also proven effective at reversing shrinkage due to TRT.
In the case of anabolic steroid use, studies have shown that it takes, on average, nine months for the body to begin producing LH on its own again. Once hormone levels normalize, many past steroid users regain partial testicular volume. By the end of the 18-month study, most participants still suffered from some level of abnormal shrinkage.
Testicular atrophy related to testicular torsion is also reversible so long as treatment occurs within a few hours of the initial onset of symptoms. Prolonged loss of blood flow will cause cell and tissue death, reducing testicular volume, and in some cases, require complete removal of one or both testicles.
A 2021 study found that 73.3% of patients in the subject pool experienced testicular atrophy following torsion, which also correlated with the subjects who waited longer before seeking treatment.
Age-related testicular atrophy is not reversible. Andropause, or the reduction of testosterone associated with age, is a natural process that typically begins when men reach their late 40s.
This loss of male hormones is a gradual process, as is the associated testicular atrophy, but can increase rapidly as men enter their 60s and 70s.
In addition to testicular atrophy, symptoms of andropause include decreased muscle mass, a drop in libido, sudden changes in mood, and trouble sleeping. A doctor who suspects that a case of testicular atrophy is related to andropause will likely ask about these related symptoms during diagnosis.
When to Get Help
Men who notice sudden or dramatic changes in their testes should usually seek medical attention, particularly if things seem to be getting worse. Problems with the sex organs usually indicate that something bigger is going wrong somewhere else, and the sooner it is identified the more likely it is to be cured.
