Normal Age-Related Changes in Scrotal Anatomy
The increased laxity and lower position of your testicles is a normal physiological change that occurs with aging, primarily due to progressive relaxation of the cremasteric muscle and stretching of the scrotal ligaments and skin over time.
Understanding the Mechanism
This is not a medical emergency or disease process—it's a natural consequence of aging that affects all men to varying degrees. The cremasteric muscle, which normally contracts to pull the testicles closer to the body for temperature regulation and protection, gradually loses tone with age. Additionally, the scrotal skin and supporting structures (including the dartos muscle and scrotal ligaments) undergo age-related changes that reduce elasticity and firmness.
What This Is NOT
Before accepting this as normal aging, you should rule out conditions that require medical attention:
- Testicular torsion - This would present with sudden, severe scrotal pain, not gradual changes over a year 1
- Acquired cryptorchidism - This involves a testis ascending upward (opposite of your situation) and becoming stuck in the inguinal canal 2
- Hydrocele or varicocele - These would cause asymmetric swelling or a "bag of worms" feeling, not just symmetric sagging 1
- Inguinal hernia - This would present with a bulge that increases with straining, not just scrotal laxity 1
When to Seek Medical Evaluation
You should see a physician if you experience:
- Pain, swelling, or tenderness in the testicles or scrotum 1
- Asymmetric changes (one side significantly different from the other) 1
- Palpable lumps or masses within the testicular tissue itself 3
- Changes in testicular size (shrinkage or enlargement) 3
- Associated symptoms such as fever, urinary symptoms, or systemic illness 1
Additional Considerations
If you have diabetes, be aware that low testosterone (hypogonadism) is more common in men with diabetes and can be associated with changes in scrotal anatomy and sexual function 4. Symptoms of hypogonadism include decreased libido, erectile dysfunction, fatigue, and loss of muscle mass 4. If you're experiencing these symptoms, a morning total testosterone level should be measured 4.
Practical Recommendations
- Perform monthly testicular self-examination to monitor for any masses or asymmetric changes that could indicate testicular cancer, which has increased risk even in normally descended testes 2
- Wear supportive underwear if the increased laxity causes discomfort during physical activity
- Maintain healthy body weight, as obesity can exacerbate scrotal laxity and is associated with lower testosterone levels 4
The gradual nature of your symptoms over one year, bilateral involvement, and absence of pain strongly suggest normal aging rather than pathology. However, a single physical examination by a healthcare provider can definitively rule out any concerning findings and provide reassurance.