Testicular Atrophy is Highly Unlikely in Your Case
Based on your excellent semen parameters (80 million total motile sperm count per ejaculate), high testosterone levels, and normal testicular volumes of 10 mL bilaterally, testicular atrophy is extremely unlikely—your FSH levels of 9.9-10.2 IU/L represent "compensated hypospermatogenesis" where the pituitary increases FSH output slightly to maintain robust sperm production, not testicular failure. 1, 2
Understanding Your Hormone-Fertility Profile
Your clinical picture demonstrates preserved testicular function with compensatory FSH elevation:
Your total motile sperm count of 80 million far exceeds the normal threshold (>9 million for intrauterine insemination, >39 million total sperm per ejaculate for natural conception), confirming excellent spermatogenesis despite mildly elevated FSH 1, 3
High testosterone levels on both occasions indicate your Leydig cells (testosterone-producing cells) are functioning normally, which would not occur with true testicular atrophy 1, 2
Testicular volumes of 10 mL bilaterally are within the lower range of normal (normal range approximately 12-30 mL, with <12 mL considered small), and this likely represents your constitutional baseline rather than acquired atrophy 2
The Concept of "Compensated Hypospermatogenesis"
Your situation fits a well-described pattern where FSH elevation maintains normal fertility:
FSH levels of 9.9-10.2 IU/L fall in the "borderline elevated" range (>7.6 IU/L suggests some testicular stress, but <11-12 IU/L does not indicate primary testicular failure) 1, 4
This represents compensated primary testicular function—your pituitary increases FSH to stimulate the testes more vigorously, successfully maintaining excellent sperm production at the expense of chronically elevated FSH 5
Historical case reports document men with FSH levels of 10-15 IU/L maintaining normal fertility and fathering children, confirming that mildly elevated FSH does not preclude normal reproductive function 5, 6
Why True Testicular Atrophy is Ruled Out
Multiple factors in your presentation exclude significant testicular damage:
Primary testicular failure (true atrophy) presents with FSH typically >11-12 IU/L, often much higher (>20-35 IU/L), with low testosterone and elevated LH—your high testosterone and FSH of 9.9-10.2 IU/L do not fit this pattern 1, 2
Non-obstructive azoospermia (complete spermatogenic failure) typically shows testicular volumes <10 mL with FSH >11 IU/L—your 10 mL volumes with excellent sperm counts exclude this diagnosis 2
Men with FSH >7.5 IU/L have five- to thirteen-fold higher risk of abnormal sperm concentration compared to FSH <2.8 IU/L, but this refers to oligospermia (reduced counts), not azoospermia—your 80 million total motile sperm count demonstrates you are not in this at-risk category 4
Important Monitoring Considerations
While current function is excellent, compensated hypospermatogenesis warrants surveillance:
Men with elevated FSH and currently normal semen analysis are at higher risk for future decline in sperm parameters over time compared to men with normal FSH 7
Repeat semen analysis every 12-24 months is reasonable to detect any declining trend, particularly if you are delaying fertility plans 7
Consider sperm cryopreservation if you plan to delay fatherhood beyond 3-5 years, as progressive spermatogenic decline can occur in men with borderline FSH, though your current robust parameters are reassuring 2, 7
Critical Pitfalls to Avoid
Never start exogenous testosterone therapy if you desire current or future fertility—testosterone completely suppresses FSH and LH through negative feedback, causing azoospermia that takes months to years to recover, even with your currently excellent function 1, 2
Do not assume FSH elevation alone indicates testicular atrophy—semen analysis and testicular volume are far more reliable indicators of actual testicular function than FSH levels 1, 3
Avoid unnecessary anxiety about "borderline" FSH values—FSH shows natural variation among healthy fertile men, and some individuals maintain FSH in the 10-12 IU/L range throughout life with normal fertility 3, 5
Addressing Potentially Reversible Factors
Consider evaluation for conditions that may contribute to FSH elevation:
Check thyroid function (TSH, free T4), as thyroid disorders commonly disrupt the hypothalamic-pituitary-gonadal axis and can elevate FSH 1, 2
Assess for metabolic factors including BMI, as obesity and metabolic stress can affect gonadotropin levels—weight optimization may improve hormonal parameters if applicable 1
Evaluate for varicocele on physical examination, as correction of palpable varicoceles can improve semen quality and potentially normalize FSH 2