Is a testicular size of 3.10cm x 2.84cm x 1.94cm normal for an adult male?

Testicular Volume Assessment

The testicular dimensions you report (3.10cm x 2.84cm x 1.94cm) are significantly below normal for an adult male and indicate testicular atrophy requiring immediate clinical evaluation.

Volume Calculation and Clinical Significance

Using the ellipsoid formula (length × width × height × 0.52), your testicular volume calculates to approximately 4.5 mL, which is markedly atrophic. 1, 2

• Normal adult testicular volume ranges from 14-17 mL or greater, depending on population (Japanese men >14 mL, US men >17 mL). 3
• Volumes <12 mL are definitively considered atrophic and associated with significant pathology requiring investigation. 1, 2, 4
• Your calculated volume of ~4.5 mL represents severe testicular atrophy, falling well below even the most conservative threshold for concern. 2

Immediate Clinical Implications

This degree of atrophy warrants urgent evaluation for underlying causes and associated risks:

• Fertility impact: Testicular size correlates strongly with sperm count, concentration, and motility, with testes <14 mL showing impaired sperm quantity and quality. 5
• Hormonal dysfunction: Small testicular volume correlates with elevated FSH and LH levels and potentially decreased testosterone. 5, 6
• Cancer risk: In men under 40 years, testicular volume <12 mL carries a 34% risk of contralateral intratubular germ cell neoplasia (GCNIS), particularly if there is history of cryptorchidism or existing testicular cancer. 2, 4

Required Diagnostic Workup

You need the following evaluations immediately:

• Semen analysis to assess fertility status, as normal testicular size strongly correlates with total sperm count and concentration. 1
• Hormonal profile including FSH, LH, and testosterone levels, which show strong negative correlation with small testicular volume. 5, 6
• Karyotype testing is mandatory if azoospermia or severe oligospermia is identified, as chromosomal abnormalities have 10-fold higher incidence in severe oligospermia. 1
• Y-chromosome microdeletion analysis if sperm concentration is <1 million/mL or azoospermia is present. 1
• Detailed history focusing on cryptorchidism, prior trauma, infections, chronic diseases, or genetic conditions that cause testicular atrophy. 4

When Scrotal Ultrasound Is Indicated

Ultrasound is NOT routinely needed for size assessment alone but IS indicated if:

• There is concern for testicular mass, firmness, or pain. 1, 4
• Large hydrocele is present. 1
• Epididymal enlargement is detected. 1
• You have history of cryptorchidism or inguinal testis location. 1

Critical Pitfalls to Avoid

• Do not confuse tumor size thresholds (4 cm) with normal testicular dimensions—the 4 cm cutoff in cancer guidelines refers to tumor measurements within the testis, not overall testicular size. 4
• Do not delay genetic counseling if abnormalities are detected before proceeding with assisted reproductive technology, as genetic defects may transmit to offspring. 1
• Do not hunt for subclinical varicoceles with ultrasound—only palpable varicoceles benefit from treatment. 1

Bottom Line

Your testicular volume of approximately 4.5 mL represents severe atrophy that is not normal and requires comprehensive andrological evaluation including hormonal assessment, fertility testing, and investigation for underlying causes. 1, 2, 5, 3