Would testicular atrophy be reflected in my semen analysis results?

Testicular Atrophy and Semen Analysis

Yes, testicular atrophy would almost certainly show in your semen analysis, as testicular volume strongly correlates with sperm concentration and total sperm count. 1, 2, 3

How Testicular Atrophy Manifests in Semen Analysis

Testicular volume directly predicts semen parameters, with the strongest correlation being with sperm density, followed by total sperm count, total motile sperm count, and percentage of motile sperm. 3 The relationship is dose-dependent:

• Volumes below 10 mL: Associated with azoospermia (no sperm) 3
• Volumes below 20 mL: Associated with severe oligozoospermia (very low sperm count) 3
• Volumes below 30 mL: Associated with sperm density below normal limits 3
• Volumes below 12 mL: Definitively considered atrophic and associated with impaired spermatogenesis 1, 2

The Hormonal Connection

Elevated FSH levels above 7.6 IU/L combined with testicular atrophy strongly indicates spermatogenic failure. 1 This hormonal marker is critical because:

• Testicular volume has the strongest negative correlation with serum FSH concentrations 3
• When atrophied testes cannot produce adequate sperm, the pituitary compensates by increasing FSH production 1
• Multiple regression analysis shows FSH concentration is the only significant independent factor determining testicular volume 3

Why Semen Analysis Reflects Testicular Function

Semen analysis evaluates multiple parameters that collectively reflect testicular production and sperm maturation. 4 The assessment of combined ejaculate parameters (concentration, motility, morphology, total count) is more predictive than any single parameter. 4

Mean testicular size strongly correlates with both total sperm count and sperm concentration, making it an excellent surrogate marker for spermatogenic function. 2

Important Clinical Caveats

A single semen analysis may not capture the full picture due to natural variability. 5 However, if testicular atrophy is present:

• The semen abnormalities are typically consistent across multiple analyses 4
• The degree of impairment correlates with the severity of atrophy 3
• Both testes may be affected even in seemingly unilateral conditions 1

Physical examination findings matter: Atrophic testes typically measure less than 12 mL by orchidometer or less than 4 cm in length, and often have softer consistency. 4, 1, 2

What This Means Practically

If you have genuine testicular atrophy, your semen analysis will show abnormalities proportional to the degree of atrophy. 3 The only exception would be very early or mild atrophy where volumes are borderline (around 12-15 mL), which might show borderline semen parameters. 2

If your semen analysis is completely normal with good sperm concentration (>15 million/mL), motility (>40%), and morphology, then significant testicular atrophy is unlikely. 5, 3 Conversely, if you have documented atrophy with volumes below 12 mL, expect to see reduced sperm parameters. 1, 2