Is testicular atrophy likely with normal Follicle-Stimulating Hormone (FSH) levels, high testosterone levels, and normal total motile sperm count, despite perceived testicular size decrease?

Testicular Atrophy is Unlikely in Your Case

Based on your FSH levels (9.9-10.2 IU/L), high testosterone, and excellent total motile sperm count (80 million per ejaculate), you almost certainly do not have clinically significant testicular atrophy. Your objective fertility parameters are normal to excellent, and your hormone profile indicates preserved testicular function 1, 2.

Why Testicular Atrophy is Unlikely

Your Sperm Production is Excellent

• A total motile sperm count of 80 million per ejaculate far exceeds the normal threshold of >9 million and is actually in the high-normal range 3
• Men with true testicular atrophy typically have severely impaired sperm production (oligospermia or azoospermia), not excellent counts like yours 1, 2
• The presence of normal to high sperm counts essentially rules out significant testicular dysfunction 1

Your Hormone Profile Indicates Normal Testicular Function

• Your FSH levels of 9.9-10.2 IU/L are only mildly elevated and fall into a borderline range that typically indicates mild testicular stress, not failure 2, 4
• FSH >7.6 IU/L can indicate some degree of testicular dysfunction, but your levels are far below the FSH >11-12 IU/L threshold that indicates primary testicular failure 1, 2
• High testosterone levels directly contradict testicular atrophy—men with true atrophy have low testosterone with markedly elevated FSH and LH 2
• Your excellent sperm production despite borderline FSH suggests compensated testicular function, where slightly elevated FSH maintains normal spermatogenesis 5

Testicular Volume of 10ml Each is Likely Normal for You

• Testicular volumes of 10ml bilaterally fall within the lower end of normal range (normal is typically 12-30ml, with <12ml considered small) 6
• However, testicular size must be interpreted in context of actual function—your excellent sperm production indicates these 10ml testes are functioning normally 7, 8
• Research demonstrates that testicular size correlates with sperm production, but men with smaller testes can maintain normal fertility if sperm counts are adequate 7
• Studies show that even men with severe testicular atrophy (≤2ml) can have successful sperm retrieval rates of 55%, so your 10ml testes with excellent sperm counts represent preserved function 8

Understanding Your Perceived Changes

Why You May Feel Your Testicles Differently

• Perceived testicular size changes are often related to scrotal laxity, temperature-related cremasteric reflex variations, or changes in body composition rather than actual testicular atrophy 6
• The sensation of testicles "dangling more" and feeling them more in boxer shorts suggests increased scrotal laxity, which is unrelated to testicular volume or function 6
• Scrotal skin changes, hydrocele, or epididymal changes can alter the perception of testicular size without affecting actual testicular volume 6

Objective Measurement is Essential

• Your 10ml measurement provides objective data that supersedes subjective perception 6
• If you had true progressive atrophy over the past year, your sperm counts would be declining, not maintaining excellent levels 1, 3

What Your FSH Levels Actually Mean

FSH 9.9-10.2 IU/L Represents Mild Compensatory Response

• This FSH range indicates your pituitary is working slightly harder to maintain spermatogenesis, but it's succeeding—as evidenced by your excellent sperm counts 2, 4
• Men can have FSH in the 10-12 IU/L range while maintaining normal fertility, representing biological variation rather than pathology 4, 5
• The key distinction is that your FSH is elevated enough to maintain excellent sperm production, not elevated because of testicular failure 5

FSH Levels Show Natural Variation

• FSH can fluctuate due to pulsatile secretion, lifestyle factors, metabolic stress, and thyroid function 1
• Your stable FSH levels (9.9 to 10.2) over time suggest a consistent baseline rather than progressive deterioration 1

Critical Reassurance Points

Your Fertility Parameters are Excellent

• Total motile sperm count of 80 million is well above the threshold for natural conception and represents preserved fertility 3
• High testosterone with only mildly elevated FSH indicates your Leydig cells (testosterone-producing) and Sertoli cells (sperm-supporting) are functioning well 2

No Evidence of Progressive Testicular Failure

• Progressive testicular atrophy would manifest as declining sperm counts, rising FSH levels, and falling testosterone—none of which you have 1, 2
• Your stable hormone levels and excellent sperm production indicate stable testicular function 4

Recommended Monitoring

Repeat Semen Analysis in 3-6 Months

• Obtain one more semen analysis to confirm stability of your excellent sperm parameters 4
• This will definitively establish that your testicular function is stable rather than declining 1

Consider Formal Testicular Volume Measurement if Concerned

• If you remain concerned about size changes, scrotal ultrasound provides precise testicular volume measurement and can detect structural abnormalities 6
• Ultrasound is indicated when physical examination is difficult or when there's discrepancy between perceived and measured size 6

Avoid Testosterone Therapy

• Never use exogenous testosterone if you value your fertility—it will completely suppress your excellent sperm production through negative feedback 2, 4
• Your high natural testosterone levels indicate you have no need for supplementation 2

Bottom Line

Your 10ml testicular volume is almost certainly your normal baseline, not pathological atrophy. The objective evidence—excellent sperm counts, high testosterone, and only mildly elevated FSH—all indicate normal testicular function 1, 2, 4. Men with true testicular atrophy have severely impaired sperm production and low testosterone, neither of which applies to you 1, 2. Your perceived changes in how your testicles feel are likely related to scrotal laxity or other benign factors rather than actual volume loss 6.