Could I have testicular atrophy with a testicle size of 4cm in long axis, elevated Follicle-Stimulating Hormone (FSH) level, and impaired sperm parameters, including low sperm count (Oligospermia), reduced motility (Asthenospermia), and abnormal morphology (Teratospermia)?

Assessment of Your Testicular Status

Based on your testicular size of 4cm long axis (approximately 15-18ml volume), FSH of 10.2 IU/L, and sperm parameters showing 60 million/ml concentration with 50% motility and 10% morphology, you do NOT have testicular atrophy, and your fertility potential remains good despite the mildly elevated FSH. 1, 2

Understanding Your Testicular Size

Your testicular measurements indicate normal testicular volume, not atrophy:

• A 4cm testicular length corresponds to approximately 15-18ml volume using the Lambert formula (length × width × height × 0.71), which is well above the 12ml threshold that defines testicular atrophy 2
• Testicular volumes less than 12ml are definitively considered atrophic and associated with significant pathology, but your measurements exceed this threshold 2, 3
• The mean testicular size strongly correlates with total sperm count and sperm concentration, and your size falls within the normal fertile range 2, 4

Common pitfall to avoid: The traditional ellipsoid formula using a 0.52 coefficient systematically underestimates testicular volume and should not be used for clinical decision-making, as it may lead to inappropriate classification of testicular atrophy 2

Interpreting Your FSH Level

Your FSH of 10.2 IU/L is mildly elevated but does not indicate testicular failure:

• FSH levels greater than 7.6 IU/L suggest some degree of testicular dysfunction, but this is a sensitive threshold that doesn't mean complete spermatogenic failure 1, 5
• FSH levels are negatively correlated with the number of spermatogonia, meaning higher FSH generally indicates the testes are working harder to maintain sperm production, but production is still occurring 1
• Your FSH of 10.2 IU/L falls well below the severely elevated range (>35 IU/L) that indicates primary testicular failure 1
• Up to 50% of men with non-obstructive azoospermia and elevated FSH still have retrievable sperm, so your mildly elevated FSH with actual sperm production is entirely consistent with maintained fertility 1

Your Sperm Parameters Indicate Adequate Fertility

Your semen analysis shows normal to mildly reduced parameters that support natural conception:

• Sperm concentration of 60 million/ml significantly exceeds the WHO lower reference limit of 16 million/ml, placing you well within the normal fertile range 1
• With 50% motility and assuming normal ejaculate volume (2-3ml), your total motile sperm count (TMSC) is approximately 60-90 million, which far exceeds the 10 million threshold associated with good natural conception rates 1
• Morphology of 10% is at the borderline of normal (WHO lower limit is typically 4% by strict Kruger criteria), but this is less predictive of fertility than concentration and motility 1, 6

The assessment of combined ejaculate parameters is more predictive of testicular function than any single parameter, and your overall profile supports good fertility potential 3

Clinical Correlation: Why Your FSH is Elevated Despite Normal Testicular Size

Several reversible factors can cause mild FSH elevation without true testicular atrophy:

• Thyroid dysfunction can disrupt the hypothalamic-pituitary-gonadal axis and should be evaluated 1
• Metabolic stress, obesity (BMI >25), and elevated SHBG can affect gonadotropin levels 1
• Lifestyle factors such as smoking, poor diet, and environmental exposures may temporarily affect the HPG axis 1
• The combination of mildly elevated FSH with normal testicular size and maintained sperm production suggests compensated testicular function rather than true atrophy 1

Recommended Evaluation

To fully assess your situation and identify any reversible causes:

• Measure LH and total testosterone to determine if this represents primary gonadal dysfunction versus secondary hypogonadism 1
• Check thyroid function (TSH, free T4) as thyroid disorders commonly affect reproductive hormones 1
• Assess prolactin to exclude hyperprolactinemia, which can elevate FSH 1
• Consider SHBG measurement to calculate free testosterone, as elevated SHBG can affect bioavailable testosterone 1
• Repeat semen analysis in 3-6 months to establish whether sperm parameters are stable or declining, as single analyses can be misleading due to natural variability 1, 3

Critical Actions to Preserve Fertility

Never use exogenous testosterone or anabolic steroids if you desire future fertility, as these completely suppress FSH and LH through negative feedback, causing azoospermia that can take months to years to recover 1

Other protective measures include:

• Smoking cessation, maintaining healthy body weight, and minimizing heat exposure to the testes 1
• Avoid medications that suppress the hypothalamic-pituitary-gonadal axis, including opioids and corticosteroids 3
• Consider sperm cryopreservation if follow-up analyses show declining trends, though this is not urgently indicated given your current parameters 1

Bottom Line

You do not have testicular atrophy. Your testicular size is normal, your sperm production is adequate for natural conception, and your mildly elevated FSH represents compensated testicular function rather than failure. Focus on identifying and correcting any reversible causes of the FSH elevation, and avoid any interventions (especially testosterone therapy) that could harm your fertility. 1, 2, 3