Is a 55 million per milliliter sperm count with a follicle-stimulating hormone (FSH) level of 10.4, within the normal range of 1-12.4, indicative of testicular atrophy in a male of reproductive age?

Assessment of Testicular Atrophy Risk

Your sperm count of 55 million/mL with FSH of 10.4 IU/L does NOT indicate testicular atrophy, but rather suggests mild testicular dysfunction with preserved spermatogenesis that warrants monitoring.

Understanding Your Test Results

Your parameters fall into a borderline category that requires careful interpretation:

• Sperm concentration of 55 million/mL significantly exceeds the WHO lower reference limit of 16 million/mL, placing you well within the normal fertile range 1
• Total sperm count of 181.5 million (55 million/mL × 3.3 mL) is excellent and far above thresholds associated with fertility concerns 1
• FSH of 10.4 IU/L is mildly elevated but not severely so—it falls well below the FSH >35 IU/L threshold that indicates primary testicular failure 1

What FSH 10.4 Actually Means

The elevation in your FSH suggests compensatory pituitary activity rather than testicular atrophy:

• FSH levels >7.6 IU/L indicate some degree of testicular dysfunction, with studies showing a five- to thirteen-fold higher risk of abnormal sperm parameters compared to men with FSH <2.8 IU/L 2
• However, FSH levels alone cannot definitively predict fertility status—up to 50% of men with non-obstructive azoospermia and elevated FSH still have retrievable sperm 1
• Your FSH of 10.4 IU/L with normal sperm count indicates oligospermia pattern, not testicular atrophy, which would typically present with FSH >15-20 IU/L and severely reduced or absent sperm 1

Testicular Atrophy: What It Actually Looks Like

True testicular atrophy has distinct clinical features you likely don't have:

• Physical examination findings: Testicular volumes <12 mL measured by Prader orchidometer or ultrasound 1, 3
• Hormonal pattern: FSH typically >15-20 IU/L, often with elevated LH and low testosterone 1
• Semen analysis: Severe oligospermia (<5 million/mL) or azoospermia (zero sperm), not your count of 55 million/mL 1, 4
• Ultrasound findings: Non-homogeneous testicular architecture, reduced testicular volume, and decreased blood flow 4

Why Your Results Don't Indicate Atrophy

The disconnect between your mildly elevated FSH and normal sperm count is actually reassuring:

• Men with true testicular atrophy typically have FSH >15-20 IU/L with severely reduced sperm counts (<5 million/mL) or azoospermia 1, 4
• Your sperm concentration of 55 million/mL indicates preserved spermatogenesis, meaning your testes are producing sperm effectively despite mild FSH elevation 1
• FSH increases with age—sperm concentration decreases by 2.1% per year and FSH increases by 0.27% per year in fertile men 5

Essential Next Steps

To fully assess your testicular function and rule out progressive dysfunction:

1. Measure complete hormonal panel: LH, total testosterone, and SHBG to calculate free testosterone 1

   • Normal LH with elevated FSH argues against primary testicular failure 1
   • Low testosterone with elevated FSH/LH confirms primary testicular dysfunction 1

2. Physical examination by urologist: Assess testicular size with Prader orchidometer, check for varicocele, and evaluate testicular consistency 1, 3

   • Testicular volumes <12 mL definitively indicate atrophy 3
   • Varicocele can elevate FSH and impair spermatogenesis but is treatable 1

3. Repeat semen analysis in 3-6 months: Establish whether parameters are stable or declining 1

   • Single analyses can be misleading due to natural variability 1
   • Declining trends warrant more aggressive evaluation 1

4. Consider genetic testing if sperm count drops below 5 million/mL: Karyotype analysis and Y-chromosome microdeletion testing 1, 4

Important Caveats and Protective Actions

Several factors can reversibly elevate FSH without indicating permanent testicular damage:

• Thyroid dysfunction disrupts the hypothalamic-pituitary-gonadal axis—check TSH, free T4 1
• Metabolic stress, obesity (BMI >25), and elevated SHBG affect gonadotropin levels—weight normalization may improve hormonal parameters 1
• Never use exogenous testosterone or anabolic steroids if fertility is desired—these suppress FSH/LH through negative feedback, causing azoospermia that can take months to years to recover 1
• Avoid gonadotoxic exposures: smoking, excessive heat to testes, certain medications 1

Fertility Outlook

Your current parameters indicate good fertility potential:

• Total motile sperm count (TMSC) of approximately 90-100 million (assuming 50% motility) far exceeds the 10 million threshold associated with good natural conception rates 1
• Couples with male TMSC >10 million have >90% chance of achieving pregnancy within 2-3 years of trying if female partner is under 30 1
• Consider sperm cryopreservation if follow-up shows declining trend—this provides insurance against future deterioration 1