Are testicular measurements of 3.5cm x 2.84cm x 2.04cm indicative of testicular atrophy?

Testicular Measurements Assessment

Your testicular measurements of 3.5cm x 2.84cm x 2.04cm calculate to approximately 10.5 mL using the Lambert formula (Length × Width × Height × 0.71), which falls below the 12 mL threshold that definitively indicates testicular atrophy and warrants further clinical evaluation. 1

Understanding Your Measurements

• Testicular volumes less than 12 mL are definitively considered atrophic and associated with significant pathology, including impaired spermatogenesis and increased risk of intratubular germ cell neoplasia (TIN). 1

• Your calculated volume of approximately 10.5 mL places you in the atrophic range, which requires clinical correlation with your symptoms, fertility status, and risk factors. 1

• Mean testicular size strongly correlates with total sperm count and sperm concentration, with volumes below 12-14 mL associated with impaired testicular function. 2

Critical Risk Factors That Determine Next Steps

High-risk scenarios requiring immediate workup include:

• Age under 30-40 years with testicular volume <12 mL: This carries a ≥34% risk of intratubular germ cell neoplasia in the contralateral testis if testicular cancer is present. 1

• History of cryptorchidism (undescended testicles): This substantially increases cancer risk and mandates closer surveillance, particularly when combined with small testicular volume. 1

• Presence of testicular cancer: Contralateral biopsy is strongly indicated given the 34% TIN risk, and if untreated, invasive testicular tumor develops in 70% of TIN-positive testes within 7 years. 3

• Infertility concerns: Volumes at this threshold warrant semen analysis and hormonal evaluation. 3

Immediate Recommended Actions

You should obtain the following evaluations:

• Detailed clinical history focusing on: cryptorchidism history, infertility concerns, family history of testicular cancer, prior testicular pathology, and any history of scrotal trauma or torsion. 1, 4

• Semen analysis: To assess sperm concentration, motility, and morphology, as testicular volume strongly correlates with total sperm count. 1

• Hormonal evaluation: Measure serum FSH, LH, and testosterone to distinguish primary testicular failure from hypogonadotropic hypogonadism. 1

• Scrotal ultrasound: Particularly important if there is a size discrepancy between testes >2 mL or 20%, to exclude structural pathology, testicular masses, or varicocele. 3, 1

When Testicular Biopsy Is Indicated

Refer for testicular biopsy if you have:

• Age <30-40 years with history of cryptorchidism. 1

• Infertility with bilateral small testes (<12 mL). 1

• Presence of testicular cancer requiring contralateral testis evaluation. 3

• Testicular atrophy (<12 mL) in the context of young age (<30 years), which warrants contralateral testis biopsy to screen for intratubular germ cell neoplasia. 3

Important Clinical Caveats

• Measurement accuracy matters: Ensure your measurements were obtained via proper ultrasound technique with high-frequency probes (>10 MHz) and three perpendicular dimensions, as technical errors can lead to incorrect volume calculations. 1

• Size discrepancy between testes: If there is a difference >2 mL or 20% between your testes, further evaluation including ultrasound is warranted to exclude pathology. 1

• Teach yourself testicular self-examination: Given increased cancer risk with smaller volumes, regular self-examination is recommended. 1

• Genetic testing considerations: Karyotype testing is strongly recommended if semen analysis shows severe oligospermia (<5 million sperm/mL) or azoospermia, as chromosomal abnormalities occur in 10% of these patients. 1