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What Is Testicular Atrophy?

By Steve R.
Updated: Mar 03, 2024

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


that 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 (


) 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.

The Health Board is dedicated to providing accurate and trustworthy information. We carefully select reputable sources and employ a rigorous fact-checking process to maintain the highest standards. To learn more about our commitment to accuracy, read our editorial process.
Discussion Comments
By anon997169 — On Nov 23, 2016

Post number 13

It is great that you have children and your life is great

I just wanted to remind that this is the blessing of God by creating every thing out of two ..

As God says in his final revelation to the human kind, the Quran, in chapter 51 verse 49 " and of all things we created two mates, perhaps you will remember"

By anon993097 — On Oct 22, 2015

I had epididymitis in my early 20's. The cause was a physical work injury causing a rupture of the left epididymis. This caused an infection and massive swelling of my left testicle. As a consequence, my left testicle has been atrophied my whole life, but the right has been normal. My semen volume has always been normal and I got married within a year of the injury and fathered two children in rapid succession. That's why we have two of everything. Nature is profligate.

By anon992655 — On Sep 21, 2015

My left is small and round like a large bing cherry. My right is big and extremely oval like a smooth oval finger potato. I feel relief squeezing the oval one into a round shape. Kinda of that painful feels good.

By anon991299 — On Jun 10, 2015

I am a 36 years old and have noticed two of my testicles have shrunken badly in the past six to seven years. I have done semen analysis x2 no sperm found including testicle biopsy. My partner and I would like to have a child but my doctor have told me there is nothing I can do about it, but did not tell me the cause of my condition. Can anybody help me or should I seek a second opinion?

By anon963914 — On Jul 31, 2014

Testicular torsion is indeed a very painful experience. I have had it twice in my life. The first time a doctor was able to unroll the cord and the relief was instant.

The second time I was not so lucky and found myself in hospital signing a piece of paper saying that they could remove the testicle if it was dead. An awful thought to have but when you are in that much pain you will sign anything. The pain is like squeezing them in a vise, and there is no relief; it just gets worse.

The surgery was fine. The removal of stitches I can't say was a pleasurable experience, but the issue never occurred again. I then went on to have kids and later had a vasectomy. The solution to stop this happening again is that the testicle is sutured to the scrotum. The same is done to the other testicle. This allows very little movement of the testicle within the scrotum and can give the impression that the testicles are small, when it could be that they just don't move around like normal.

By anon953506 — On May 27, 2014

I had mumps and have atrophied testicles, I never wanted children so luckily I don't really care about fertility. A doctor did suggest I could get fake ones implanted but as it is I find it difficult to get jeans to fit comfortably. If I had more in there, I'd feel strangled.

By anon950733 — On May 12, 2014

Can anyone advise? I am 63 years old and in the last six or seven years my testicles and penis have shrunk a great deal. I still have an active sex life but everything has definitely gotten a lot smaller.

By amypollick — On Jun 13, 2012

@anon274690: If you're having these problems, you need to see a doctor. Reduce your soy intake and see if you see a change, but see a doctor, also.

By anon274690 — On Jun 13, 2012

I am 22 years old, and I have been eating soy products since I was 18. Now today I realize they have bad effects on men. Soy products start producing mammary glands in men and lower the level of testosterone.

Today I found that I had shrunken testicles, and even the size of my penis is small, because of lower testosterone production. Even my body is very sensitive, like a girl's, etc. Please help me. How can I overcome this problem naturally or by any way?

By anon274455 — On Jun 11, 2012

@VivAnne: One needs to understand her male anatomy a little better. It's impossible for the "sperm lines leading to each of the two testes get twisted around each other". The real "nightmare fodder" is that people can read a wiki or similar factoid, and start lecturing people on things they don't have any idea about.

By TheGraham — On Jul 28, 2011

@hanley79 - I have to disagree with you here. While it's true that a man who chose to take steroids knowing they would shrink things would have nobody to blame but himself, we've got to remember that most people aren't well-informed when they take steroids.

Steroid users are frequently athletes under pressure to perform better, and don't understand much about how steroids work short of knowing that they're illegal but that they will give a person bigger muscles. If men start taking steroids out of pressure and end up with testicular atrophy as a result, I must say I feel quite sorry for them.

By hanley79 — On Jul 28, 2011

So this is why men who take steroids having "shrinking packages", huh? My boyfriend is a wrestler, and he always talks jokingly about how you can tell which guys take steroids because certain body parts will shrink even as the rest of their bodies bulge with new muscles.

As far as testicular atrophy causes go, taking steroids has to be one of the dumbest ones, because it's the man's choice to do it. What man in his right mind would choose to take something that is going to shrink his package, I ask you?

Now if the man has testicular atrophy for some other more legit reason, like as a side effect of chemotherapy, then I can sympathize with him. The steroid users I don't feel sorry for -- they brought it upon themselves.

By gimbell — On Jul 28, 2011

@VivAnne - Yeah, acute testicular torsion sounds not only very scary, but also extremely uncomfortable. Thankfully, it can be treated with a full recovery (no testicular atrophy -- phew) so long as you don't ignore the symptoms and go in to the doctor promptly.

If a man develops sudden and acute testicular pain, he should get to the Emergency Room immediately. If it's acute testicular torsion, he has about six hours before one or both testes completely die from lack of blood flow.

I would say "run, don't walk", but neither is going to be very comfortable. Have a friend carry you if you must, but get in to the Emergency Room as soon as possible. Don't be one of those people who thinks the Emergency Room bill will be too high -- this is literally your manhood at stake, here!

By VivAnne — On Jul 27, 2011

I found this article after looking up acute testicular torsion -- another not-at-all-fun-sounding testicle condition in which the sperm lines leading to each of the two testes get twisted around each other (most commonly one around the other) and cut off blood flow to one of the testes.

If left untreated long enough, testicular torsion can in fact lead to "killing" one of the testes, which will then atrophy and can even develop gangrene unless it is surgically removed. New nightmare fodder, huh, guys?

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