Testicular Atrophy and Physical Examination Findings
In testicular atrophy, the testicles typically feel softer and smaller, not tighter—the reduced tissue mass and loss of normal seminiferous tubule architecture result in a softer, less firm consistency on palpation. 1
Physical Examination Characteristics
Testicular atrophy presents with reduced testicular volume (typically <12 ml) and softer consistency compared to normal testes, which is a key finding during physical examination that helps distinguish atrophic from normal testicular tissue 2, 1
The Prader orchidometer provides a good surrogate for volume measurement and allows clinicians to assess both size reduction and the characteristic softer feel of atrophic testes during examination 3
Physical examination should specifically assess testicular size, consistency, and presence of associated abnormalities such as varicoceles or epididymal abnormalities, as these findings help determine the underlying cause and severity of atrophy 1
Pathophysiological Basis for Texture Changes
Testicular atrophy results from loss of seminiferous tubule architecture and reduction in spermatogenic cells, which causes the testis to become smaller and softer rather than firmer or tighter 4, 5
The reduction in Leydig cells and vacuolation of Sertoli cells that occurs with prolonged atrophy further contributes to the softer consistency 4
Ischemic causes of testicular atrophy, such as testicular torsion or trauma, lead to tissue loss and replacement with less dense tissue, resulting in a softer feel 6, 5
Clinical Assessment Approach
Scrotal ultrasound can provide accurate testicular volume assessment when physical examination findings are uncertain or when there is significant size discrepancy between testes (>2 ml or 20%) 2, 3
High-frequency probes (>10 MHz) should be used to maximize resolution and accurate assessment of testicular parenchyma when ultrasound is performed 2, 3
Men with testicular atrophy require monitoring for potential development of testicular cancer, as atrophic testes (<12 ml) carry increased risk of malignancy, particularly in men under 30-40 years with history of cryptorchidism 2, 1
Important Clinical Caveats
A firm or hard testicular mass within an otherwise atrophic testis should raise immediate concern for testicular malignancy and warrants urgent urological evaluation 2, 1
Bilateral testicular atrophy with elevated FSH levels (>7.6 IU/L) strongly suggests primary testicular dysfunction and spermatogenic failure, requiring hormonal evaluation and genetic testing if severe oligospermia or azoospermia is present 1, 7
Even with severe testicular atrophy (volume ≤2 ml), microsurgical testicular sperm extraction (micro-TESE) achieves sperm retrieval rates of approximately 55%, particularly in younger men with Klinefelter syndrome 8