There are several potential reasons for the testes shrinking, including aging, underlying medical conditions, or infections.
In this article, learn more about the causes, symptoms, and treatment of testicular atrophy.
What is testicular atrophy?
Aging is a common cause of testicular atrophy.
Testicular atrophy is when the testes shrink. In the case of testicular atrophy, the testes get smaller due to a loss of some of the germ cells and Leydig cells.
Germ cells produce sperm while Leydig cells produce testosterone.
If the testes shrink, a person could have a lower sperm count, lower testosterone levels, or both, due to the loss of these cells.
Testicular atrophy differs from the shrinking that occurs due to cold temperatures. In cooler temperatures, the scrotum retracts or shrinks, pulling the testes closer to the body to maintain warmth. In warmer temperatures, it loosens, allowing the testes to cool.
Possible causes of testicular atrophy include:
- testicular cancer
- excessive alcohol usage
- hormone imbalance
- testicular torsion
Over time, the testes will likely begin to shrink. This is a natural process, as the body produces less testosterone or sperm after the peak reproductive years.
Hormonal imbalances can sometimes cause testicular atrophy. If the body is driven to produce less testosterone, the testicles may begin to shrink.
Some potential causes of a hormone imbalance that suppress testosterone production include:
- testosterone replacement therapy
- taking estrogen
- anabolic steroids
- certain medications
Orchitis is an infection that causes pain and inflammation in the testicles. Either a virus or bacterial infection may cause orchitis.
Some of the common causes of orchitis include:
- intestinal bacteria that travels up the reproductive tract following anal intercourse
- urinary tract infections (UTIs)
- surgery on the urinary tract
- use of a catheter
Certain diseases or infections may increase the risk of testicular atrophy, including mumps and HIV.
Treatment may reverse the atrophy, depending on the severity of the shrinkage.
Excessive alcohol usage
Regularly consuming excessive amounts of alcohol may cause a decrease in testosterone levels.
Excessive alcohol consumption can also cause testicular tissue damage, which may result in testicular atrophy.
Testicular torsion happens if a testicle rotates, twisting the spermatic cord that connects the testes to the rest of the reproductive tract.
In addition to pain and swelling, the twisted cord causes blood loss to the testicles. If a person does not receive prompt treatment, the loss of oxygen and blood flow could lead to permanent testicular atrophy.
Varicocele refers to when the veins that run through the scrotum become enlarged. Varicocele typically occurs on the left side only.
In many cases, a person may not realize they have varicocele, as it may not cause any symptoms. However, they may notice that the left testicle appears smaller than usual.
In rare cases, testicular cancer can cause testicular atrophy. According to the American Cancer Society, the average age for a diagnosis of testicular cancer is 33.
While testicular cancer tends to affect younger men, it is highly treatable.
Often the most obvious symptom of testicular atrophy is the noticeable shrinkage of one or both testicles.
However, depending on the person's age and underlying conditions, a person may notice some additional symptoms.
Those who have not yet gone through puberty may notice a:
- larger penis size
- lack of facial or pubic hair
If testicular atrophy occurs after puberty, additional symptoms may include:
- soft testicles
- lower sex drive
- reduced muscle mass
- reduced facial or pubic hair
If an underlying medical condition is causing testicular atrophy, a person may also experience:
- pain in the testicles
To diagnose testicular atrophy, a doctor will conduct a physical examination.
A doctor will normally start to diagnose testicular atrophy by asking questions about the individual's lifestyle and medical history. They will also ask about any medications a person is taking.
A doctor will also likely conduct a physical examination of the testicles, looking at the following qualities:
Finally, a doctor may order some additional tests to help determine what is causing the testicular atrophy. Possible tests include:
- an ultrasound of the testicles to look at abnormalities and blood flow
- blood work to look for signs of infection
- swabs or urine tests to test for sexually transmitted infections
- hormone level tests
How a doctor treats testicular atrophy depends on its underlying cause. Possible treatments may include:
- antibiotics for an infection
- lifestyle changes
- hormone therapy
- surgery, particularly in cases of testicular torsion
If a person discovers testicular atrophy early and receives treatment as soon as possible, it might be possible to reverse the shrinkage.
Some conditions, such as testicular torsion, require immediate treatment to avoid permanent damage to the testicle.
Do natural treatments work?
Some people claim there are natural treatments for testicular atrophy. There is no clinical evidence to suggest that any natural remedies can correct testicular atrophy or its underlying causes.
People should be aware of the regular size and shape of their testicles. If one or both of the testicles become noticeably smaller, it is best to speak to a doctor as soon as possible.
There is more chance to reverse testicular atrophy with early intervention and treatment.