Could I have testicular atrophy with a testicle size of 3.5cm, elevated Follicle-Stimulating Hormone (FSH) level, low sperm count (Oligospermia), and abnormal semen parameters, including reduced motility and morphology?

Testicular Assessment: Likely Normal Spermatogenesis with Borderline Testicular Reserve

Your testicular size of 3.5cm (approximately 15-18ml volume) is within normal range, and your FSH of 10.2 IU/L with sperm concentration of 60 million/ml indicates you do NOT have testicular atrophy—you have normal spermatogenesis with mildly reduced testicular reserve. 1, 2

Understanding Your Testicular Size

Your testicular long axis of 3.5cm corresponds to a volume of approximately 15-18ml, which is above the 12ml threshold that defines testicular atrophy 2. The American Urological Association and European Association of Urology define testicular atrophy as volumes below 12ml, and your measurements place you in the normal range 1, 2.

• A 3.5cm testicular length correlates with 15-18ml volume using proper ultrasound measurement techniques 2
• Testicular volumes of 15-18ml are associated with normal spermatogenesis and adequate fertility potential 2
• Your sperm concentration of 60 million/ml far exceeds the WHO lower reference limit of 16 million/ml, confirming normal testicular function 3

Interpreting Your FSH Level

Your FSH of 10.2 IU/L is mildly elevated but does not indicate testicular atrophy or failure 1, 3. This pattern represents "compensated hypospermatogenesis"—your testes are producing normal sperm counts but working harder to do so 4.

• FSH >7.6 IU/L indicates the pituitary is compensating for some degree of testicular resistance, but this does not mean atrophy 1, 3
• Men with FSH levels in your range (10-12 IU/L) typically have oligospermia or normal sperm counts, not azoospermia 3
• Your actual sperm parameters (60 million/ml concentration, 50% motility, 10% morphology) confirm preserved spermatogenesis despite the elevated FSH 1, 5

Your Fertility Status

You have normal fertility potential based on your semen parameters 3. Your total motile sperm count (TMSC) is approximately 30 million per ejaculate (60 million/ml × 50% motility × assumed 1ml volume), which far exceeds the 10 million threshold associated with good natural conception rates 3.

• Sperm concentration of 60 million/ml places you well within the fertile range 3
• Motility of 50% exceeds the WHO lower reference limit of 40% 3
• Morphology of 10% exceeds the WHO lower reference limit of 4% 3

Important Caveat: Monitor for Decline

While you currently have normal sperm production, men with elevated FSH and normal semen analysis are at higher risk for future decline in sperm parameters 4. This is the key concern with your profile.

• Men with FSH ≥7.6 IU/L and initially normal semen analysis are more likely to develop oligospermia over time compared to men with normal FSH 4
• At each follow-up timepoint, more men with elevated FSH developed sperm concentration below 15 million/ml 4
• This represents "compensated hypospermatogenesis"—your testes are maintaining normal output now but have reduced reserve capacity 4

Recommended Actions

Repeat semen analysis in 3-6 months to establish whether your parameters are stable or declining 3. This is critical for men in your situation.

• If parameters remain stable, repeat annually to monitor for decline 3
• If sperm concentration drops below 15 million/ml or TMSC falls below 10 million, consider sperm cryopreservation 3
• Avoid exogenous testosterone or anabolic steroids completely, as these will suppress FSH/LH and cause azoospermia that can take months to years to recover 1, 6

Measure complete hormonal panel including LH, total testosterone, and SHBG 1, 3. This helps distinguish primary testicular dysfunction from secondary causes and identifies reversible factors.

• Normal LH with elevated FSH suggests primary testicular resistance rather than pituitary dysfunction 3
• Check thyroid function (TSH, free T4), as thyroid disorders commonly affect reproductive hormones and are reversible 1
• Elevated SHBG may reduce bioavailable testosterone even with normal total testosterone 3

Optimize modifiable factors that affect spermatogenesis 3:

• Smoking cessation if applicable 3
• Maintain healthy body weight (BMI 20-25) 1
• Minimize heat exposure to testes (avoid hot tubs, laptop on lap, tight underwear) 3
• Optimize metabolic health and glycemic control if diabetic 1

When Genetic Testing Is Needed

Genetic testing is NOT indicated at your current sperm concentration 1, 3. Karyotype and Y-chromosome microdeletion testing are only recommended if:

• Sperm concentration drops below 5 million/ml 1, 3
• You develop azoospermia 1, 3
• You have severe oligospermia with testicular atrophy (volume <12ml) 1

Your current parameters do not meet these thresholds.

Bottom Line

You do not have testicular atrophy. Your testicular size is normal, and your sperm production is currently normal. The mildly elevated FSH indicates reduced testicular reserve, meaning you should monitor for future decline and avoid anything that could further impair spermatogenesis. If you're planning to have children, don't delay unnecessarily, and consider sperm banking if parameters decline on follow-up testing.