Testicular atrophy involves abnormally reduced testicles (shrunken testicles). Severely reduced testicles are usually no longer functional, i.e. neither hormones nor intact sperm are produced. Causes include years of abuse of anabolic steroids, but also genetic defects, such as Klinefelter syndrome, or inflammation of the testicles.
What is testicular atrophy?
Under a testicular atrophy, the medical profession understands conspicuously reduced testicles. While normal-sized testicles have a volume of about three cubic centimeters, shrunken testicles are sometimes only about one cubic centimeter in size. Shrunken testicles are usually no longer functional – the man suffers from azoospermia and – if both testicles are affected – is unable to conceive. The sex hormones produced in the testicles – especially testosterone – are no longer produced.
Causes
The causes of testicular atrophy vary widely. Shrunken testicles are relatively common in athletic circles, where anabolic steroids are consumed in large quantities to help build muscle. Another cause is various congenital genetic defects, such as Klinefelter syndrome. In addition, an untreated and not completely healed inflammation of the testicle can lead to a shrunken testicle. As part of gender reassignment therapy, transsexual men can cause shrunken testicles by taking concomitant female sex hormones (estrogens) to prevent the testes from releasing the male sex hormone testosterone in an unwanted manner. Less commonly, the cause of testicular atrophy may be circulatory problems (varicocele) or general trauma.
Symptoms, complaints, and signs
Visually, testicular atrophy can be recognized by the significant reduction in testicular volume. In addition, there is sometimes pain and an uncomfortable feeling of pressure in the testicular area. There may be discoloration of the scrotum, which increases in the course of the disease and clearly indicates atrophy of the testicles. Testicular atrophy is also associated with infertility and erectile dysfunction. If testicular atrophy is based on inflammation, it usually progresses insidiously and unnoticed. Those affected often only notice it when erection problems occur repeatedly or a desire to have children remains unfulfilled over a long period of time. If medication or growth hormones are the cause, a shrunken testicle usually develops quite quickly and without pain. The testicular atrophy itself does not result in any further physical complaints. However, it can sometimes lead to severe psychological problems. Due to the reduction in size of the testicles and the associated infertility, inferiority complexes, social anxiety and depression can set in. Often the partners are also affected by the psychological discomfort. For this reason, it is advisable to consult a doctor at the first symptoms of testicular atrophy. Early treatment can often reverse the atrophy and avert the threat of infertility.
Diagnosis and progression
A urologist can diagnose a shrunken testicle relatively easily because it is clearly visible. To clarify the exact size, the urologist may perform sonography (ultrasound examination). If the causes of testicular atrophy are not obvious – for example, in the case of gender reassignment therapy of transsexual men or in the presence of Klinefelter’s syndrome – the urologist will clarify the causes as part of the diagnosis, such as the presence of a varicocele or inflammation. In addition, the urologist can check the functionality of the testicles by performing a spermiogram. If azoospermia is present, there are no sperm at all in the ejaculate. In this case, the testicles have stopped functioning and the man is unable to conceive. The course or formation of a shrunken testicle varies greatly depending on the cause. While testicular atrophy caused by inflammation usually progresses gradually and unnoticed and is only noticed when the desire to have a child is not fulfilled, a shrunken testicle formed as a result of taking medication or anabolic steroids forms quite quickly. The formation of testicular atrophy is usually painless.
Complications
The severe reduction in size of the testicles leaves them without function in most cases. This can mean not only physical but also severe psychological discomfort for the patient.As a rule, this results in infertility, which not infrequently can lead to depression or lowered self-esteem. Often, inferiority complexes also occur as a result. Not infrequently, the partners are also affected by psychological complaints and thus also suffer from testicular atrophy. Furthermore, testicular atrophy has no particular negative effects on the health of the affected person. In many cases, the psychological complaints can be treated by a psychologist without complications. Also, the life expectancy of the patient is usually not affected by the disease and therefore not reduced. If the testicular atrophy occurs due to a circulatory disorder, this is usually treated first. Furthermore, other means of pregnancy can be used in the female partner. Not infrequently, the symptom also occurs in people who want to undergo a sex change operation. However, testicular atrophy is not treated in this case. No other complications occur as a result of this condition.
When should you go to the doctor?
Testicular atrophy does not always require medical treatment. Less severe shrunken testicles regress on their own once the causative drug is discontinued. Disease-related testicular atrophy should be clarified by a specialist. Thus, children suffering from Klinefelter’s syndrome or a comparable disease require medical treatment in any case. Parents should consult a physician at the first sign of testicular atrophy and have the symptoms examined and treated if necessary. If the shrunken testicles are accompanied by pain or other symptoms, medical treatment is also required. Men who are infertile due to testicular atrophy are best to talk to their family doctor. Accompanying this, a visit to a therapist may also be useful. In any case, abnormally reduced testicles must be examined in order to narrow down the possible causes and take appropriate countermeasures. Individuals who have suffered from testicular atrophy since birth are best advised to speak to a specialist. It is often possible to insert implants or to enlarge the shrunken testicles through hormonal measures.
Treatment and therapy
Depending on the cause, the treatment of a shrunken testicle varies greatly. If the shrunken testicle is intentional – which is the case for transgender men who want to undergo sex reassignment surgery – a shrunken testicle is not treated. If the shrunken testicle has been triggered by the use of anabolic steroids, it is advised to refrain from further use of the preparations. Sometimes the shrunken testicles regress after discontinuation of the preparations. The same applies in the presence of a circulatory disorder – after surgical removal of the varicocele, the blood flow can be normalized. The consequences of a shrunken testicle can be counteracted by the administration of various medications containing testosterone. If the man already suffers from azoospermia, artificial insemination with simultaneous TESE can be used to try to induce pregnancy in the female partner. If the shrunken testicle causes pain or the man suffers from its appearance, removal of the shrunken testicle and insertion of an implant may be considered.
Outlook and prognosis
In testicular atrophy, the testicles are significantly reduced in size. In addition, there is pain and an uncomfortable feeling of pressure in the testicular region. In addition, discoloration or sensory disturbances may occur. Testicular atrophy is usually accompanied by erectile dysfunction or even infertility. If an inflammation is the cause of the shrunken testicles, the signs of the disease become increasingly severe. The atrophy is often not noticed until repeated erection problems occur or the testicles have already become significantly smaller. As the disease progresses, the pain can radiate to the buttocks and abdomen, causing patients to feel very unwell. Untreated testicular atrophy can lead to the loss of one or both testicles. On the other hand, psychological complaints develop, such as depression or inferiority complexes. If the testicular atrophy is due to drug abuse, there may be a variety of accompanying symptoms.Possible symptoms associated with shrunken testicles include digestive problems, cardiovascular problems such as palpitations or blood pressure fluctuations, and skin changes such as acne or redness. If the cause of testicular atrophy is not corrected, the condition progresses progressively and, depending on the trigger, can lead to organ dysfunction, infertility and mental disorders. Atrophy treated early often resolves without late sequelae.
Prevention
Shrunken testicles themselves cannot be prevented. However, every man can minimize the risk of developing an (unwanted) shrunken testicle. This includes refraining from taking anabolic steroids as well as going to the urologist as soon as the affected person feels pain that indicates an inflammation of the testicle. If the man feels a varicose vein (varicocele), he should also consult a doctor. As a rule, early treatment of a shrunken testicle can prevent the consequence of azoospermia with inability to conceive.
Aftercare
The aftercare of testicular atrophy depends on the cause of the disease and the therapy given. If anabolic steroid abuse was the underlying cause, anabolic steroids must not be consumed even after completion of therapy, otherwise there is a risk of renewed atrophy. If a circulatory disorder due to a varicose vein was the cause and the therapy involved surgical removal of this varicocele, the patient must cool his scrotum with ice for the first 24 hours after the procedure to prevent bleeding and swelling. On the following day, a control examination by means of ultrasound and a wound check is performed, with subsequent discharge of the patient. During the first week, the patient must not perform any heavy physical work or exercise. Afterwards, a check-up with the local urologist is indicated, to whom the discharge letter from the clinic is to be given. Six weeks after the operation, the final check-up takes place in the treating clinic. At this time, any disturbing remnants of the self-dissolving suture material can be removed. If the prescribed testosterone therapy does not result in a significant long-term reduction of the atrophy to the original size, the removal of the testicle and the insertion of an implant can be considered. This is advocated in the presence of pain or psychological suffering as a result of aesthetics. After six to twelve months, a semen examination can be performed to determine the remaining fertility.
What you can do yourself
What those affected by testicular atrophy can do themselves depends on the cause of the condition. If a particular medication is responsible for the testicular atrophy, treatment consists of stopping the responsible drug or changing the medication. If the shrunken testicles occur after taking anabolic steroids, the causative drug should be discontinued. Accompanying medical clarification of the testicular atrophy is always necessary. In most cases, medication must be taken to promote recovery. Under certain circumstances, an individual diet can help to treat the shrunken testicles. This always depends on how severe the testicular atrophy is and whether there are accompanying symptoms. Testicular atrophy that occurs in connection with a sex change is desired by the affected person and therefore does not need to be treated. In the case of azoospermia, testicular atrophy can no longer be counteracted. The most important self-help measure is to reduce any psychological suffering by going to a support group at an early stage. Sometimes seeing a therapist is also useful. Pain can be alleviated by various natural remedies to accompany drug treatment. However, this should be discussed with the treating physician beforehand.
