Are my testicles shrinking with a testosterone level of 35 nmol/L, Luteinizing Hormone (LH) of 7, sperm count of 70 million/mL, and Follicle-Stimulating Hormone (FSH) of 10.2?

Testicular Atrophy Assessment

Based on your hormone profile showing testosterone 35 nmol/L (normal), LH 7 IU/L (normal), FSH 10.2 IU/L (mildly elevated), and sperm count 70 million/mL (normal), your testicles are not likely undergoing pathological atrophy, though the mildly elevated FSH suggests your testes are working harder to maintain normal function. 1

Understanding Your Hormone Pattern

Your hormonal profile represents compensated testicular function rather than testicular failure 2:

• Testosterone 35 nmol/L: This is in the high-normal to elevated range, making primary testicular failure unlikely 1
• LH 7 IU/L: Normal range argues strongly against primary testicular dysfunction, which would show elevated LH 1, 3
• FSH 10.2 IU/L: Mildly elevated (above the 7.6 IU/L threshold), indicating your pituitary is compensating for some degree of testicular resistance, but not severely so 1, 3
• Sperm count 70 million/mL: This far exceeds the WHO lower reference limit of 16 million/mL, confirming preserved sperm production 3

True testicular atrophy presents with testosterone below normal, FSH typically much higher than 10.2 IU/L, elevated LH, and reduced or absent sperm production—none of which apply to you. 2

What the Mildly Elevated FSH Means

FSH levels are negatively correlated with spermatogonia numbers, meaning higher FSH indicates the pituitary is working harder to maintain sperm production 1. Your FSH of 10.2 IU/L suggests:

• Your testes have some degree of reduced efficiency but are successfully compensating 1
• Men with FSH 10-12 IU/L typically have oligospermia (reduced counts), but your count of 70 million/mL is normal, indicating good testicular reserve 1
• This pattern is not consistent with progressive testicular atrophy 2

Why Your Testicles May Appear Smaller

Several reversible factors can cause temporary changes in testicular size without representing true atrophy:

Physiological variation:

• Testicular size fluctuates with temperature, cremasteric reflex activity, and hydration status 4
• Cold exposure causes testicular retraction and apparent size reduction 4

Metabolic and hormonal factors to evaluate:

• Thyroid dysfunction: Disrupts the hypothalamic-pituitary-gonadal axis and can affect testicular size 1
• Weight changes: Obesity and metabolic stress affect gonadotropin levels 1
• Medications: Certain drugs can temporarily affect testicular function 1

Essential Next Steps

Measure testicular volume objectively using an orchidometer or ultrasound to establish baseline 2:

• Normal adult testicular volume is 15-25 mL per testis 2
• Volumes below 15 mL suggest some degree of testicular dysfunction 3
• Subjective assessment is unreliable—you need objective measurement 2

Complete hormonal evaluation 3, 2:

• Total testosterone and SHBG to calculate free testosterone
• Prolactin to exclude hyperprolactinemia
• TSH and free T4 to assess thyroid function
• These identify reversible causes of mildly elevated FSH

Repeat semen analysis in 3-6 months to establish whether parameters are stable or declining 2:

• Single analyses can be misleading due to natural variability 3
• Declining trends would warrant closer monitoring and possible sperm cryopreservation 2

Critical Monitoring Parameters

If testicular volume is objectively normal (>15 mL per testis), your perceived size reduction is likely physiological variation or measurement error 2.

If testicular volume is reduced (<15 mL per testis), this explains the mildly elevated FSH, but your normal testosterone, LH, and sperm count indicate this is compensated dysfunction, not progressive atrophy 2.

Repeat FSH and testicular volume measurement in 6-12 months to establish stability versus progression 2:

• Stable or improving parameters are reassuring
• Rising FSH with declining testicular volume would indicate progressive dysfunction requiring fertility preservation discussion

Common Pitfalls to Avoid

Never start testosterone therapy if you have any interest in current or future fertility 2:

• Exogenous testosterone completely suppresses FSH and LH through negative feedback 1, 2
• This eliminates intratesticular testosterone production and causes azoospermia 2
• Recovery can take months to years after discontinuation 1

Do not assume pathology based on subjective size assessment alone 2:

• Testicular size perception is notoriously unreliable
• Objective measurement with orchidometer or ultrasound is mandatory for accurate assessment

Address reversible factors before concluding this represents permanent dysfunction 1, 2:

• Thyroid optimization, weight management, and metabolic control may normalize FSH 1
• Recheck hormones after addressing these factors 1

Bottom Line

Your hormone profile and sperm count indicate preserved testicular function with mild compensatory elevation in FSH, not testicular atrophy 1, 2. The perceived size reduction requires objective measurement to distinguish physiological variation from true volume loss. Even if volume is mildly reduced, your normal testosterone, LH, and excellent sperm count confirm this is compensated function, not progressive failure 2.