What does testicular shrinkage mean?
The main volume of the testicle is made up of seminiferous tubules, in which sperm are formed. When this tissue is damaged and replaced by connective tissue, the organ decreases in size and becomes denser or, conversely, flabby.
Cells that produce testosterone are more stable, so with moderate atrophy, hormonal function can persist for a long time, while spermatogenesis suffers earlier. With severe and bilateral atrophy, testosterone levels also decrease.
The volume of the testicles is assessed by ultrasound; The estimated norm for an adult male is about 12–25 milliliters for each person. Not only the absolute number is important, but also the difference between the parties and the dynamics during repeated studies.
Reasons
- Varicocele - long-term disruption of blood flow and overheating; one of the most common and avoidable causes, especially significant in adolescents
- Previous orchitis due to mumps is a classic cause, especially if the disease was suffered after puberty
- History of testicular torsion, even successfully operated
- Taking anabolic steroids and testosterone drugs - suppress the production of pituitary hormones, the testicles become smaller
- Cryptorchidism, including after reduction surgery
- Chemotherapy and radiation therapy
- Scrotal injuries
- Severe infections: epididymo-orchitis, tuberculosis of the genitourinary system
- Operations in the groin area with damage to the vessels of the spermatic cord
- Chronic alcoholism and liver cirrhosis
- Hypogonadotropic hypogonadism and pituitary diseases
- Genetic causes, including Klinefelter syndrome
- Age-related changes
Symptoms and consequences
- Visible or palpable shrinkage of one or both testicles
- Scrotal asymmetry
- Changes in spermogram up to azoospermia
- Infertility
- Decreased sexual desire and erection quality in a bilateral process
- Fatigue, decreased muscle mass, weight gain
- Gynecomastia
- Reduced bone density with long-term testosterone deficiency
- Psychological discomfort
- Often - absence of any sensations with unilateral atrophy
Diagnostics
- Examination by an andrologist to assess the size and consistency of the testicles
- Ultrasound of the scrotum with measurement of the volume of each testicle and Doppler ultrasound is the main method
- FSH and LH - an increase indicates primary testicular damage, a decrease indicates a pituitary gland problem
- Total testosterone in the morning on an empty stomach, free testosterone if necessary
- Prolactin, estradiol, TSH
- Spermogram
- Karyotype and microdeletions of AZF with severe atrophy and azoospermia
- Tumor markers for a suspicious ultrasound picture
- MRI of the pituitary gland with low FSH and LH
- Densitometry for long-term testosterone deficiency
The combination of indicators explains a lot: high FSH and LH with a small testicular volume indicate a primary lesion of the tissue itself, while low values of these hormones indicate insufficient stimulation from the pituitary gland - and this condition is often treatable.
What can be restored
- Atrophy caused by steroids or testosterone is often reversible after withdrawal, sometimes with stimulant therapy; recovery takes months
- Hypogonadotropic hypogonadism is one of the few forms in which hormonal stimulation can restore both testicular volume and spermatogenesis.
- Atrophy due to varicocele in adolescents - after microsurgery, testicular growth often catches up with healthy
- Atrophy after inflammation is partially reversible with early and complete treatment
- Atrophy after torsion, prolonged ischemia, severe chemotherapy and for genetic reasons is usually irreversible
Treatment and tactics
- Microsurgical varicocelectomy for varicocele with proven testicular growth retardation
- Complete withdrawal of anabolic steroids and exogenous testosterone
- Stimulating hormone therapy to restore your own production - as prescribed by your doctor
- Testosterone replacement therapy for confirmed deficiency in men who do not plan to have children
- Treatment of identified infectious and inflammatory diseases
- Cryopreservation of sperm with preserved spermatogenesis - especially before chemotherapy and with progressive atrophy
- Micro-TESE and ICSI for azoospermia
- Installation of a testicular prosthesis if desired by the patient
- Control of bone density, lipids and glucose in long-term hormone deficiency
- Regular monitoring with ultrasound and hormonal control
Where to get examined in Tashkent
You need an ultrasound of the scrotum with an accurate measurement of volume, a hormonal profile, a spermogram and an appointment with an andrologist.
In Tashkent, such examination and treatment of removable causes, including microsurgical surgery for varicocele, is carried out at the UROLOGIC COMPLEX medical center and at the Tashkent Medical Park clinic.
Be sure to tell your doctor about taking steroids, having mumps, injuries and surgeries in the groin area, even if it was a long time ago: it is this information that most often explains the picture and determines the tactics. Clinic contacts are below.
