Testicular Atrophy: Causes, Symptoms, and Treatment
What is Testicular Atrophy?
The testicles are crucial organs in the male reproductive system. They serve two primary functions: producing sperm and secreting testosterone (the male sex hormone). Additionally, the testicles play a significant role in the development of secondary male sex characteristics.
In some cases, the testicles may be smaller than normal, leading to serious problems. This article provides general information about testicular atrophy.
In testicular atrophy, the testicles shrink within the scrotum or decrease in size. This can occur due to various reasons and should be treated promptly to prevent permanent damage. Testicular atrophy differs from normal shrinkage or expansion of the scrotum muscles.
In the latter case (changes in scrotum size), this is a natural response of the body to fluctuations in environmental temperature. When the external temperature decreases, the scrotum contracts, and when the temperature rises, the scrotum relaxes or expands. In this case, there is no change in the size of the testicles.
What is the Normal Testicular Size?
In adults, the normal testicle is approximately 5 cm long, 2 cm wide, and 3 cm high. The average testicular volume in adults is about 18 ml.
What are the Causes of Testicular Atrophy?
The causes of testicular atrophy are very diverse. Many factors, from testicular inflammation to cancer, can cause testicular atrophy. We can list the causes of testicular atrophy as follows:
- Orchitis: Orchitis is an inflammatory disease of the testicles. It can be unilateral or bilateral. At the beginning of orchitis, the testicle is large and painful. Later, after treating the infection and eliminating the disease, a reduction in the size of the testicle occurs, i.e., atrophy. The extent of this atrophy varies depending on the severity of the infection and appropriate and timely treatment. There are two types of orchitis depending on the cause:
- Viral orchitis: The causative agent here is a virus. The most common cause of viral orchitis is orchitis resulting from mumps. About one-third of men who contract mumps after puberty develop orchitis after 4-7 days.
- Bacterial orchitis: Orchitis caused by bacteria. It is more common than viral orchitis. It is more common in sexually active men. It often develops due to sexually transmitted diseases such as gonorrhea and chlamydia. Additionally, bacterial orchitis can be seen as a result of urinary tract infections, insertion of a urinary catheter, or endoscopic procedures.
Varicocele
Varicocele is the enlargement of the veins in the testicle (testicular veins), also known as varicose veins. It is often seen on the left side and sometimes bilaterally. If varicocele is not treated, the size of the testicle decreases over time, leading to atrophy.
It is one of the significant conditions that cause testicular atrophy in young men. Atrophy can be prevented if diagnosed and treated early. However, if testicular atrophy develops due to varicocele in adulthood, surgery cannot reverse the condition.
In cases of childhood varicocele, surgery can correct the atrophy, and the testicles can return to their normal size. For this reason, varicocele in children should not be neglected.
Testicular Torsion
This condition occurs when the spermatic cord, which contains the testicular blood vessels, twists around itself, leading to insufficient blood flow to the testicle. Testicular torsion is a medical emergency that requires intervention within hours. Failure to intervene in time can result in testicular atrophy.
The most effective treatment is surgically untwisting the spermatic cord and securing the testicle in the scrotum.
Aging
As men age, the size of their testicles decreases. Testicular atrophy due to aging is bilateral, meaning there is a reduction in the size of both testicles.
Excessive Alcohol Use
In those who drink excessive amounts of alcohol, serum testosterone levels (the male hormone produced by the testicles) decrease, and the size of the testicles diminishes. Alcohol-induced testicular atrophy is bilateral, meaning it affects both testicles.
Receiving External Testosterone Treatment
One of the most important functions of the testicles is to produce testosterone. Some individuals take testosterone externally (testosterone replacement therapy). In this case, the testicles do not function, and their size decreases, leading to testicular atrophy.
Use of Estrogen or Anabolic Steroids
Men who receive anabolic steroids or external estrogen treatments develop testicular atrophy in the same way as those taking testosterone. The atrophy in these individuals is typically bilateral.
Trauma
As a result of trauma to one or both testicles, atrophy may develop.
Undescended Testicle (Cryptorchidism)
Sometimes, the testicles are not in their natural position at birth and descend later. In such cases, the testicles should be brought down into the scrotum by the age of one. If the testicles are not descended in time or are descended too late, atrophy may develop.
Surgical Procedures
Testicular atrophy can occur as a result of surgeries where the testicular vessels are negatively affected. This is often seen in cases like hernia surgery and varicocele surgery. If great care is not taken during the surgery, the arteries of the testicle may be damaged, leading to atrophy.
In microscopic varicocele surgery, testicular atrophy does not develop because the artery is visible using a microscope.
How is Testicular Atrophy Diagnosed?
If you visit a doctor to confirm testicular atrophy, it is likely that the diagnosis will begin with an analysis of your medical history and questions about your daily diet, lifestyle, and sexual habits.
Afterward, the doctor may perform a physical examination of the testicles to assess their structure, size, firmness, texture, etc. If it is difficult to reach a clear conclusion, further investigation may be suggested, such as a testicular ultrasound or a testosterone level test, or a detailed blood test.
Later, the doctor will conduct a physical examination to evaluate the condition of the testicle and check for:
- Pain
- Swelling
- Texture
- Firmness
- Size
In addition to identifying the underlying cause of the condition, the doctor may recommend additional tests such as:
Complete blood count
- Testicular ultrasound
- Testosterone level test
How is Testicular Atrophy Treated?
Treatment options for testicular atrophy depend on the underlying cause:
- Hormone replacement therapy: This treatment helps reduce the effects of hormonal imbalance on testicular atrophy and assists in restoring testicular function.
- Antibiotics and antivirals: Certain medications can combat infections and prevent further damage.
- Surgery: Surgical interventions can improve blood flow and potentially reverse atrophy in cases of varicocele or testicular torsion.
- Lifestyle changes: Reducing alcohol consumption, managing stress, and maintaining a healthy weight can improve testicular health.
Can People with Testicular Atrophy Have Children?
One common question from patients is, “Does testicular atrophy cause infertility?” If the atrophy is unilateral and the other testicle is normal in size and functioning properly, these individuals can still have children.
Do Atrophied Testicles Produce Sperm?
Even if there are no sperm in the semen of patients with testicular atrophy, sperm may be found in the testicle under a microscope (TESE) in some patients, enabling them to have children through in vitro fertilization.
Does Testicular Atrophy Cause Erectile Dysfunction?
If one testicle is atrophied and the other is normal, patients will not experience sexual dysfunction because testosterone levels will remain normal. However, if the atrophy is bilateral and testosterone levels are low, erectile dysfunction may occur. An atrophied testicle can also have a psychological impact, leading to erectile issues as a result.
Should an Atrophied Testicle Be Surgically Removed?
If the testicular atrophy is severe and the other testicle is healthy, the atrophied testicle should be surgically removed. This is because there is a high risk of cancer developing in the future.
How Should Patients with Testicular Atrophy Be Monitored?
Patients with testicular atrophy should be regularly examined if they do not wish to have the atrophied testicle removed. Since testicular cancer is common between the ages of 18-38, this period is considered risky in terms of cancer development. These patients should be monitored through physical examinations, scrotal ultrasound, and tumor markers (Alpha-fetoprotein, LDH-1, and Beta HCG).
Is There a Medication to Treat Testicular Atrophy?
There is no medication available to enlarge an atrophied testicle. Herbal treatments also have no effect on increasing the size of a small testicle.
What Does the Term “Hypoplastic Testicle” Mean?
Hypoplasia refers to the underdevelopment of an organ before birth due to a small number of congenital cells. In other words, hypoplasia is a small size due to insufficient development of the organ. The hypoplastic organ displays the anatomical characteristics of the entire tissue and functions.
What Is the Difference Between an Atrophied Testicle and a Hypoplastic Testicle?
Hypoplasia refers to a smaller organ due to developmental issues that occur during the prenatal period. Atrophy, on the other hand, is a decrease in the number of cells in an organ that had developed normally, leading to the organ and tissue being smaller than their normal size. In other words, hypoplasia is a congenital condition, while atrophy refers to the shrinking of the organ that occurs later.
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