Testicular Atrophy Does Not Cause Squishy Testicles
Testicular atrophy refers to a reduction in testicular volume (typically below 12 mL), not a change in consistency or firmness—atrophic testicles remain firm on palpation, not soft or "squishy." 1, 2
Understanding Testicular Atrophy
Testicular atrophy is defined by volume reduction below 12 mL, which correlates with impaired spermatogenesis and reduced germ cell populations, but this process does not alter the fundamental consistency of the testicular parenchyma. 1, 2
- Atrophic testes maintain normal firmness because the tunica albuginea (the fibrous capsule) and the basic structural architecture remain intact despite loss of germ cells within the seminiferous tubules. 3
- The histological changes in atrophy involve progressive depopulation of seminiferous tubules, with loss of spermatids and spermatocytes, but the Sertoli cells and basement membrane persist, maintaining structural integrity. 4
- Volume reduction occurs due to shrinkage of tubular diameter as germ cells are lost, not due to liquefaction or softening of testicular tissue. 4
What Actually Causes Soft or Squishy Testicles
A soft or squishy testicular consistency suggests different pathology entirely, unrelated to simple atrophy:
- Acute inflammation or infection (orchitis/epididymitis) can cause testicular swelling and tenderness with altered consistency, which may warrant a trial of antibiotics if epididymitis is suspected. 5
- Testicular torsion causes ischemia and can lead to eventual atrophy if not corrected, but the acute phase presents with a swollen, tender testis, not a soft one. 3
- Hydrocele or fluid collections surrounding the testis can create a sensation of softness, but ultrasound easily distinguishes this from true testicular pathology. 1
- Testicular tumors typically present as firm or hard masses, not soft tissue—a painless solid testicular mass is pathognomonic for testicular tumor. 5
Clinical Evaluation of Abnormal Testicular Consistency
If a testis feels genuinely soft or squishy on examination, this warrants immediate ultrasound evaluation to exclude acute pathology such as torsion, tumor, or severe inflammation. 5, 1
- Testicular ultrasound serves to confirm the presence of a testicular mass and explore the contralateral testis, and is particularly indicated when there is a palpable abnormality, large hydrocele, or marked size discrepancy between testes. 5, 1
- Physical examination should assess for testicular consistency, presence of varicocele, epididymal abnormalities, and vas deferens patency, as these factors influence diagnosis independent of volume. 6
- A size discrepancy greater than 2 mL or 20% between testes warrants ultrasound evaluation to exclude pathology, regardless of absolute volume or consistency. 1
Common Pitfall to Avoid
Do not confuse volume reduction (atrophy) with consistency changes (softness)—these represent fundamentally different clinical findings with distinct differential diagnoses. Atrophy is a chronic process resulting in small but firm testes, while soft consistency suggests acute or inflammatory pathology requiring urgent evaluation. 1, 2, 3