Is testicular atrophy likely in a male of reproductive age with a follicle-stimulating hormone (FSH) level of 9.9 mIU/mL and a low sperm count of 56 million/mL in a 3.3 mL semen sample?

Is Testicular Atrophy Likely with Your FSH and Sperm Count?

Testicular atrophy is unlikely in your case. Your FSH of 9.9 mIU/mL is only mildly elevated and your sperm count of 56 million/mL (total count 184.8 million) is well above the normal threshold, making significant testicular atrophy improbable. 1

Understanding Your Hormone and Sperm Parameters

Your results indicate compensated hypospermatogenesis rather than testicular atrophy:

• FSH of 9.9 mIU/mL is mildly elevated (normal range 1-12.4), suggesting your pituitary is working slightly harder to maintain sperm production, but this level does not indicate testicular failure 1
• Sperm concentration of 56 million/mL significantly exceeds the WHO lower reference limit of 16 million/mL, placing you well within the normal fertile range 1, 2
• Total sperm count of 184.8 million (56 million/mL × 3.3 mL) far exceeds the WHO threshold of 39 million per ejaculate 2

What Testicular Atrophy Actually Looks Like

True testicular atrophy presents very differently from your situation:

• Physical findings: Testicular atrophy is characterized by small, soft testes (typically <12 mL volume) that are palpable on examination 1
• FSH levels: Non-obstructive azoospermia with testicular atrophy typically shows FSH >7.6 IU/L, often much higher (>12-16 IU/L), combined with zero sperm in the ejaculate 1
• Your scenario: You have sperm counts in the normal range, making significant testicular atrophy highly unlikely 1, 2

The Significance of Your Mildly Elevated FSH

Your FSH level suggests compensated testicular function rather than failure:

• Men with FSH >7.5 IU/L have a five- to thirteen-fold higher risk of abnormal sperm parameters compared to men with FSH <2.8 IU/L, but this means reduced counts, not necessarily zero 3
• FSH levels are negatively correlated with spermatogenesis—higher FSH indicates the pituitary is compensating for some degree of testicular resistance—but your actual sperm production remains robust 1, 4
• Critical distinction: FSH of 9.9 with normal sperm counts indicates your testes are responding adequately to hormonal stimulation, which would not occur with true testicular atrophy 1

Important Monitoring Considerations

While testicular atrophy is unlikely, your mildly elevated FSH warrants attention:

• Risk of decline: Men with elevated FSH (≥7.6 IU/L) and currently normal semen analysis are at higher risk for subsequent decline in sperm parameters over time compared to men with normal FSH 5
• Repeat testing: Obtain repeat semen analysis in 3-6 months to establish whether your parameters are stable or declining, as single analyses can be misleading 1
• Physical examination: Have a male reproductive specialist assess testicular size, consistency, and presence of varicocele to objectively evaluate for atrophy 1

Protective Actions to Maintain Fertility

To prevent any future decline in testicular function:

• Never use exogenous testosterone or anabolic steroids, as these completely suppress FSH and LH through negative feedback, causing azoospermia that can take months to years to recover 1, 2
• Optimize modifiable factors: smoking cessation, maintain healthy body weight (BMI <25), minimize heat exposure to testes 1
• Consider sperm cryopreservation if follow-up analyses show declining trends, as this provides insurance against future deterioration 1

When Physical Examination Is Essential

You should undergo testicular examination to definitively rule out atrophy:

• Testicular volume measurement using Prader orchidometer or ultrasound can objectively assess for atrophy (normal volume is 15-25 mL per testis) 1
• Varicocele assessment on standing examination is important, as varicocele repair can stabilize or improve testicular function in men with abnormal semen parameters 1
• Testicular consistency evaluation helps distinguish between different causes of elevated FSH 1

Bottom Line

Your combination of mildly elevated FSH with normal-to-high sperm counts makes testicular atrophy very unlikely. However, the elevated FSH indicates you have reduced testicular reserve and should monitor your fertility parameters over time. Physical examination remains the definitive way to assess for testicular atrophy. 1, 2, 5