Have my testicles atrophied given a testicular volume of 10ml, normal luteinizing hormone (LH) levels, serum testosterone levels of 38 nanomoles per liter, and abnormal follicle-stimulating hormone (FSH) levels?

Testicular Volume Assessment

Your testicular volume of 10ml bilaterally represents borderline testicular atrophy, falling just below the 12ml threshold that definitively indicates small or atrophic testes, and warrants further investigation given your hormonal profile. 1

Understanding Your Testicular Volume

• Testicular volumes less than 12ml are generally considered small or atrophic and are associated with impaired spermatogenesis and higher risk of intratubular germ cell neoplasia. 1
• Your bilateral volume of 10ml places you in a concerning range that requires clinical correlation with your hormonal and semen parameters. 1
• The sensation of testes "dangling lower" does not change the actual measured volume—10ml is an objective measurement that indicates reduced testicular size regardless of position. 1

Your Hormonal Profile Interpretation

Your FSH of 10.2 IU/L (upper normal range) combined with 10ml testicular volumes indicates compensated primary testicular dysfunction—your pituitary is working harder to maintain adequate sperm production from testes with reduced reserve. 1, 2

• FSH levels above 7.6 IU/L suggest some degree of testicular dysfunction, and your level of 10.2 IU/L indicates your pituitary is compensating for impaired spermatogenesis. 2
• Your LH of 7.0 IU/L and testosterone of 38 nmol/L (normal) argue against complete primary testicular failure—if your testes were severely failing, both LH and testosterone would be more abnormal. 2, 3
• This pattern (borderline-elevated FSH, normal LH, adequate testosterone, reduced testicular volume) is classic for oligospermia with reduced testicular reserve. 2

Your Semen Analysis Context

Your sperm parameters confirm that despite borderline atrophic testes, you currently maintain sperm production, though at suboptimal levels. 1, 4

• Sperm concentration of 56 million/ml exceeds the WHO lower reference limit of 16 million/ml, indicating you are currently producing adequate numbers of sperm. 1
• However, motility of 50% and morphology of 8% are both below optimal thresholds, consistent with the impaired spermatogenesis expected from 10ml testes. 4
• Mean testicular size strongly correlates with total sperm count and sperm concentration—your reduced testicular volume directly explains your suboptimal semen parameters. 1, 4

Clinical Significance and Risk Assessment

The combination of 10ml testicular volume, FSH at 10.2 IU/L, and suboptimal semen parameters indicates you have reduced testicular reserve with ongoing risk of progressive spermatogenic failure. 1, 2

High-Risk Features Requiring Action:

• If you are under 30-40 years old with testicular volume <12ml, you have a >34% risk of intratubular germ cell neoplasia if testicular cancer were to develop. 5, 1
• History of cryptorchidism (undescended testicles) substantially increases cancer risk and mandates closer surveillance with these volumes. 5, 1
• Testicular volumes <12ml are associated with impaired spermatogenesis and potential progressive decline in fertility. 1

Essential Next Steps

Obtain detailed history focusing on cryptorchidism, family history of testicular cancer, prior testicular pathology, and any medications or exposures that could affect testicular function. 1

• Perform physical examination checking for varicocele presence, testicular consistency, size discrepancy between testes (>2ml or 20% warrants ultrasound), and vas deferens patency. 1, 2
• Repeat semen analysis in 3-6 months to establish whether parameters are stable or declining, as single analyses can be misleading due to natural variability. 2, 6
• Consider scrotal ultrasound to exclude structural pathology, testicular masses, or varicocele, and to confirm accurate volume measurement. 1

Genetic Testing Indications:

• If repeat semen analysis shows sperm concentration declining to <5 million/ml, obtain karyotype analysis to exclude Klinefelter syndrome and Y-chromosome microdeletion testing (AZFa, AZFb, AZFc regions). 2, 3
• Genetic testing is mandatory if concentration drops below 1 million/ml. 2

Fertility Preservation Considerations

Given your reduced testicular reserve (10ml volumes, elevated FSH), strongly consider sperm cryopreservation now while parameters remain adequate, as progressive spermatogenic failure is a real risk. 2

• Men with elevated FSH and small testicular volumes are at risk for progressive decline, and once azoospermia develops, even microsurgical testicular sperm extraction only achieves 40-50% retrieval rates. 2
• Collect at least 2-3 ejaculates for cryopreservation if possible to provide backup samples. 2
• Your current sperm concentration of 56 million/ml is adequate for successful cryopreservation. 2

Critical Management Pitfalls to Avoid

Never use exogenous testosterone or anabolic steroids if you desire future fertility—these will completely suppress FSH and LH through negative feedback, causing azoospermia that can take months to years to recover. 2, 6

• Avoid heat exposure to testes (hot tubs, saunas, tight underwear, laptop use on lap). 2
• Smoking cessation and maintaining healthy body weight optimize spermatogenesis. 2
• Teach testicular self-examination given increased cancer risk with smaller volumes. 1

When to Seek Urgent Urology Referral

• Development of palpable testicular mass 2
• Rapid testicular atrophy or size change 2
• Progression to severe oligospermia (<5 million/ml) or azoospermia 2
• Age <30 years with history of cryptorchidism (requires testicular biopsy consideration) 5, 1