Should I be concerned about my small testicle size, normal testosterone levels, and borderline elevated Luteinizing Hormone (LH) and Follicle-Stimulating Hormone (FSH) levels affecting my fertility plans in the next 2-3 years?

Your Fertility Outlook is Reassuring Despite Borderline Hormones

Based on your normal testosterone, excellent sperm parameters (50 million/ml with 50% motility and adequate volume), and only mildly elevated FSH/LH, you should not be significantly worried about achieving pregnancy in the next 2-3 years—your current fertility status appears adequate for natural conception. 1

Understanding Your Hormone Pattern

Your FSH (9.5 IU/L) and LH (7.0 IU/L) sit at the upper end of normal, which indicates your pituitary is working slightly harder to maintain testicular function, but this pattern is not consistent with testicular failure 1. Here's why this matters:

• FSH >7.6 IU/L suggests some degree of testicular stress, but levels below 11-12 IU/L typically correlate with oligospermia (reduced counts) rather than azoospermia (no sperm), and your counts are actually normal 1
• Your normal testosterone (42 nmol/L) and only mildly elevated LH argue strongly against primary testicular failure, which would show much higher FSH (typically >15-20 IU/L) with low testosterone 1
• The combination of borderline-high FSH with normal LH and adequate testosterone is the classic pattern of compensated testicular function—your pituitary is compensating successfully 1

Your Sperm Parameters Are Actually Good

Let's put your numbers in perspective:

• 50 million/ml exceeds the WHO lower reference limit of 16 million/ml by threefold 1
• 50% motility is adequate (WHO reference is >40% total motility) 1
• 3 ml volume is normal (WHO reference is >1.5 ml) 1
• 5% normal morphology meets the WHO threshold of ≥4% 1

These parameters indicate you have sufficient sperm for natural conception despite your small testicular volume 1.

Small Testicular Size: What It Means

Your 10-12 ml testicular volume is below the typical adult range (15-25 ml), but this finding must be interpreted in context:

• Small testes with elevated FSH typically indicate reduced spermatogenic capacity, but your actual sperm production contradicts this concern 1
• Testicular volume correlates imperfectly with fertility—some men with smaller testes maintain adequate sperm production, as you clearly do 1
• The discrepancy between small volume and normal sperm counts suggests your testicular tissue is functioning efficiently despite reduced size 1

Critical Next Steps Before Your 2-3 Year Timeline

1. Address Reversible Factors That May Be Elevating FSH

Check for metabolic stressors that can artificially elevate gonadotropins 2:

• Measure TSH and free T4 to exclude thyroid dysfunction, which commonly disrupts the hypothalamic-pituitary-gonadal axis and can elevate FSH 2
• Calculate BMI and assess for obesity or being underweight, as both extremes affect gonadotropin levels 2
• Review medications and supplements that might interfere with testosterone production 2
• Repeat hormonal testing after 3-6 months of metabolic optimization—FSH often normalizes to 7-9 IU/L once reversible factors resolve 2

2. Rule Out Varicocele

Perform a focused physical examination for varicocele (dilated scrotal veins), as this is present in 35-40% of infertile men and can cause both elevated FSH and reduced testicular volume 3:

• Varicocele repair may improve both hormonal parameters and testicular function if a clinical (palpable) varicocele is found 3
• Treatment is most beneficial when FSH is <11.7 IU/L, which applies to your case 3
• Do not pursue ultrasound for subclinical varicoceles—only palpable varicoceles warrant treatment 3

3. Consider Genetic Testing Only If Parameters Worsen

You do NOT need genetic testing now given your normal sperm counts, but obtain it if:

• Sperm concentration drops below 5 million/ml on repeat testing 1
• FSH rises above 12 IU/L with declining sperm parameters 1
• Testing would include karyotype analysis (to exclude Klinefelter syndrome) and Y-chromosome microdeletion screening 1

4. Protective Measures for Your Timeline

Consider sperm cryopreservation as insurance 1:

• Men with borderline FSH and small testicular volumes face risk of progressive spermatogenic decline 1
• Banking sperm now (ideally 2-3 samples) provides backup if parameters deteriorate before your 2-3 year conception window 1
• This is especially prudent given your small testicular volume, which suggests limited testicular reserve 1

Repeat semen analysis every 6-12 months to monitor for declining trends 1:

• If concentration drops below 15 million/ml or motility falls below 40%, accelerate fertility plans 1
• Progressive decline would warrant earlier referral to reproductive endocrinology 1

Critical Pitfalls to Avoid

Never Start Testosterone Therapy

If you develop symptoms of low testosterone (fatigue, low libido), absolutely refuse testosterone replacement 1, 2:

• Exogenous testosterone completely suppresses FSH and LH through negative feedback, causing azoospermia that can take months to years to reverse 1, 2
• Your current testosterone of 42 nmol/L is adequate—symptoms are more likely related to other factors 1

Don't Delay If Female Partner Has Fertility Concerns

Your fertility window is also constrained by your partner's age and ovarian reserve 1:

• If your partner is >35 years old or has diminished ovarian reserve, consider earlier fertility evaluation 1
• Assisted reproductive technology (IVF/ICSI) offers superior pregnancy rates compared to waiting for spontaneous conception when time is limited 1

Treatment Options If Parameters Decline

Should your sperm counts drop or FSH rise further:

• FSH analogue injections may modestly improve sperm concentration in men with FSH <12 IU/L, though benefits are limited 1, 2
• Aromatase inhibitors or selective estrogen receptor modulators (clomiphene) have been used off-label with modest benefits 1, 2
• Assisted reproductive technology remains the most effective option if natural conception fails after 6-12 months of trying 1

Bottom Line

Your current fertility status is adequate for natural conception despite borderline hormones and small testicular size. The key is monitoring for decline and addressing any reversible factors (thyroid, varicocele, metabolic issues) that may be stressing your testicular function. With your current sperm parameters, you have a reasonable chance of achieving pregnancy naturally within your 2-3 year timeline, but consider sperm banking as insurance given your limited testicular reserve 1, 2.