Why does testosterone shrink your balls

Why does testosterone shrink your balls? Testicular shrinkage is a common side effect of testosterone injections, which can actually be avoided.

In this article, I’m going to show you why it happens and how to avoid it. And if it’s even something to worry about.

Quick Facts: 

TRT inhibits LH release, which is needed to create testosterone in the Leydig cells.

Intratesticular testosterone is 100 times higher than serum testosterone, which keeps the testes big and healthy.

Low intratesticular testosterone results in testicular catabolism and shrinkage.

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Why Does Testosterone Shrink Your Balls?

Why Does Testosterone Shrink Your Balls?

To understand why testosterone might cause testicle shrinkage, it’s essential to comprehend how testosterone production and regulation work in the body. The testicles, also known as testes, are responsible for producing testosterone. The brain’s pituitary gland releases luteinizing hormone (LH), which signals the testicles (specifically Leydig cells) to produce testosterone.

The Leydig cells produce testosterone and intratesticular testosterone is about 100 times higher than serum testosterone. If your serum testosterone is 800ng/dl, it will be around 80,000ng/dl in your testes.

Why Does Testosterone Shrink Your Balls? intratesticular testosterone

These high levels of intratesticular testosterone create a highly anabolic environment in the testes.

80% of testicular volume consists of germinal epithelium and seminiferous tubules (two highly androgen-sensitive tissues). When intratesticular testosterone drops, germinal epithelium and seminiferous tubules shrink, manifesting as testicular atrophy (R).

In healthy eugonadal men selected to undergo TRT, it was shown that their intratesticular testosterone levels dropped by 94%! (R) So you can imagine there will be some shrinkage happening.

The decrease in testicular size is primarily a result of shrunken cells that produce sperm. Which is why most men become infertile after a few months of TRT use.

No/low LH = no/low intratesticular testosterone.

Why Does Testosterone Shrink Your Balls?

How much will it shrink?

Getting 200mg testosterone enanthate injected weekly for 16 weeks shrunk these men’s testes by an average of 19% (23 to 18.8cc) (R). Injecting less frequently (every 3-4 weeks) resulted in an increase in testicular volume. After stopping, testicular size returned to normal in all the men.

As you can see, when intratesticular testosterone dropped by 94% (from 2774 to 166nmol/L) from TRT, testicular volume only shrank by 19%.

Why Does Testosterone Shrink Your Balls? testicular size

Interestingly, 32% of the males treated with testosterone experienced only a non-significant (7.8%) decrease in testicular volume and they remained fertile.

Does the TRT dose determine testicular shrinkage?

TRT is enough to reduce intratesticular testosterone by 94%. Using higher doses might decrease it a bit more, but even a 94% drop in intratesticular testosterone is more than enough to shut down spermatogenesis.

No, TRT dose does not matter. What might “help” is by using low dose testosterone. Low dose, like 25-50mg of testosterone per week should only reduce LH by 50%, which should still be enough to stimulate intratesticular testosterone production. However, this small amount of testosterone is unlikely to yield enough benefit compared to optimal testosterone doses for TRT (100-150mg per week).

Why Does Testosterone Shrink Your Balls? Can it be reversed

Can testicular shrinkage from TRT be reversed?

In most cases yes, but it takes time.

The decrease in testicular volume is directly related to the decrease in sperm count (R). Hence the return to full size should coincide with the amount of sperm produced.

Usually, most men produce enough sperm to be fertile again 6 months after stopping testosterone, but sometimes it can take up to 2 years.

Why Does Testosterone Shrink Your Balls? Fertility timeline

It is important to note that testicle shrinkage is not harmful or permanent. They shrink but only to a certain extent, typically stabilizing after a few months on TRT. It varies between individuals, but the decrease in size is usually mild and doesn’t affect their ability to function properly.

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How to prevent testicular shrinkage on TRT

Since the drop in LH and intratesticular testosterone are responsible for the decrease in testicular size, restoring LH or LH signaling should help to prevent it.

Option 1 – HCG

hCG has also been used to reduce some of the side effects of TRT, mainly preventing testicular atrophy and helping maintain response to TRT by β€œcycling off” TRT with a periodic replacement of therapy with hCG (R).

Injecting 250 IU of HCG every other day along with TRT results in only a 7% drop in intratesticular testosterone levels. Injecting 500 IU of hCG every other day with TRT resulted in an increase in intratesticular testosterone by 26% (R).

For men who do not desire to preserve fertility testicular size can be maintained while undergoing TRT with 1,500 IU of HCG given weekly. Which is enough to maintain pre-TRT levels of intratesticular testosterone (R).

Your options to prevent testicular shrinkage include:

  • 250-500IU of HCG every other day
  • 1500IU of HCG once a week

If you don’t like injections, go for the once-a-week option.

Option 2 – DHEA and androsterone

DHEA is a steroid produced in the adrenal glands and usually declines with TRT use. Androsterone is a 5-alpha-reduced steroid created from DHEA.

The combination of DHEA and androsterone is highly anabolic to androgenic tissue (e.g. seminiferous tubules in the testes) (R). Therefore it might help to apply 5mg DHEA + 2.5 to 5mg androsterone to the testes daily. This should maintain a high androgenic environment and prevent testicular shrinkage.

Does testicular size correlate with testosterone production

In rare cases (anecdotal feedback) testicular size doesn’t return to normal. So the question arises, does small testes produce less testosterone?

It has long been assumed that larger testicles would lead to higher testosterone production. Higher intratesticular testosterone = more and bigger germinal epithelium and seminiferous tubules = high quantity sperm = bigger testes. Makes sense right?

Why Does Testosterone Shrink Your Balls?

However, research has shown mixed results in establishing a direct link between testicular size and testosterone levels. Some studies have found a positive correlation, suggesting that larger testicles indeed produce higher testosterone (R, R). Conversely, other studies have failed to establish a clear relationship, indicating that factors other than size may be involved in testosterone production.

The use of total testicular volume and body mass index together for predicting testosterone levels yields a sensitivity and specificity of 85.3% and 86.5% respectively (R). This means that testicular size only predicts testosterone levels with 85% sensitivity. However, on the flip side, men can have normal testicular size but have low testosterone.

Sperm quantity had stronger correlations with testicular size than did sperm quality (R). The amount of sperm produced is the biggest determining factor for testicular size.

Additional Factors Influencing Testicle Size

While TRT can contribute to temporary testicle shrinkage, it’s essential to understand that there are other factors influencing testicle size as well. These include:

Infertility: Fertility is a stronger correlator of testicular size. Low LH often leads to low intratesticular testosterone, which then leads to poor fertility. But intratesticular testosterone could be normal and yet someone can have low sperm production. This could also cause reduced testicular size.

Temperature: The testicles function best at temperatures slightly lower than the rest of your body. Therefore, factors that increase testicular temperature, such as hot baths or tight underwear, may affect their size temporarily.

Age: Testicle size naturally decreases with age, even without the influence of testosterone therapy. This is a normal part of the aging process.

Genetic Factors: e.g. Klinefelter syndrome.

Health Conditions: e.g. varicocele, heavy metal overload or other toxin accumulation.

Too short or long sleep (R).

Understanding Temporary versus Permanent Changes

It’s crucial to distinguish between temporary and permanent changes when it comes to testicle size and TRT. As we mentioned earlier, the temporary shrinkage experienced during TRT stabilizes after a few months and is not a cause for concern. However, if you notice any additional symptoms or experience persistent pain or discomfort in your testicles, it is crucial to consult with your healthcare provider immediately to rule out any potential complications or underlying conditions.

While testicle shrinkage can be a temporary side effect, it is often outweighed by the positive effects of TRT. The treatment aims to enhance well-being and alleviate symptoms associated with low testosterone levels, improving quality of life.

Monitoring and Adjusting TRT

If you are currently on TRT or considering starting the treatment, it is essential to have regular check-ups and blood tests to monitor your hormone levels. Some people need higher doses and others lower doses. For example, obese individuals typically need higher doses to get the same levels as some that are normal weight. On the flip side, someone who is older doesn’t excrete testosterone as rapidly, so their testosterone levels might be higher at a given dose compared to someone younger.

Summary – why does testosterone shrink your balls

A drop in intratesticular testosterone shrinks sperm-producing cells. As a result, sperm production goes down and testes shrink.

This can easily be prevented by using 250IU of HCG every other day or 1500IU once a week.

Clomid is likely to be ineffective, but it can’t rescue suppressed LH induced by high androgens.

In most cases, after stopping TRT, testicular size will return to normal. Slightly shrunken testes are not harmful, so it’s nothing to worry about. If you still want to get kids, then it’s a good idea to add HCG to your TRT protocol to prevent shrinkage of the sperm-producing cells.

Other articles to take your androgens to the next level:

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