Testicular Softness and Size Changes with Normal Hormones
Understanding Your Clinical Picture
Your hormone levels and sperm parameters are reassuring and indicate preserved testicular function, despite your perception of smaller, softer testicles. Your FSH of 9.8 IU/L and LH of 7.2 IU/L fall within normal ranges and suggest your testes are responding appropriately to pituitary signals, with no evidence of primary testicular failure 1, 2.
Why Testicular Texture and Size Can Change
Normal Physiological Variations
Testicular consistency naturally varies based on cremasteric muscle tone, ambient temperature, hydration status, and time of day—the scrotum and testes are designed to change position and firmness to regulate temperature for optimal sperm production 2.
Perceived size changes often reflect measurement variability rather than true atrophy—testicular volume fluctuates with cremasteric contraction, scrotal skin thickness, and even the angle of examination 3.
Hormonal Context Matters
Your FSH of 9.8 IU/L is mildly elevated but not pathological—FSH >7.6 IU/L indicates some degree of testicular stress, but levels below 12 IU/L typically correlate with maintained sperm production rather than complete testicular failure 1, 4.
Normal testosterone and sperm production confirm functional Leydig cells and seminiferous tubules—if your testes were truly failing, you would see testosterone decline and sperm abnormalities, which you do not have 1, 2.
Essential Diagnostic Steps
Obtain Objective Measurements
Schedule a scrotal ultrasound with precise volume calculation using the Lambert formula (Length × Width × Height × 0.71) to establish baseline testicular volume—this eliminates subjective perception and provides accurate measurements 3.
Testicular volumes <12 mL are definitively considered atrophic, while volumes of 15-18 mL correspond to normal spermatogenesis—knowing your actual volume is critical for determining if intervention is needed 2, 3.
Complete Hormonal Evaluation
Measure total testosterone, SHBG, and calculate free testosterone—some men have normal total testosterone but low bioavailable testosterone due to elevated SHBG, which can affect testicular function 5, 1.
Check prolactin and thyroid function (TSH, free T4)—hyperprolactinemia and thyroid disorders disrupt the hypothalamic-pituitary-gonadal axis and can cause perceived testicular changes despite normal FSH/LH 1, 2.
Perform Semen Analysis
Obtain at least two semen analyses separated by 2-3 months—single analyses are misleading due to natural variability, and this confirms whether your sperm production truly remains normal 1, 2.
If sperm concentration drops below 15 million/mL, obtain karyotype analysis and Y-chromosome microdeletion testing to exclude genetic causes of progressive testicular dysfunction 1, 2.
Common Causes of Perceived Testicular Changes with Normal Hormones
Varicocele
Varicocele causes testicular softness and progressive atrophy through venous congestion and elevated testicular temperature, yet FSH and testosterone often remain normal until late stages 2.
Physical examination for varicocele should be performed standing—grade 2-3 varicoceles are palpable and associated with testicular volume loss over time 1, 2.
History of Cryptorchidism
- Even successfully treated undescended testicles result in smaller, softer testes with reduced spermatogenic capacity, though Leydig cell function (testosterone production) remains intact 2.
Metabolic and Lifestyle Factors
Obesity (BMI >25), poor glycemic control, and metabolic syndrome impair testicular function through inflammatory pathways affecting the hypothalamic-pituitary-gonadal axis 1.
Weight normalization and metabolic optimization can improve testicular volume and consistency in men with functional hypogonadism 1.
Critical Actions to Protect Fertility
Avoid Gonadotoxic Exposures
Never use exogenous testosterone or anabolic steroids—these completely suppress FSH and LH through negative feedback, causing testicular atrophy and azoospermia that takes months to years to recover 1, 2.
Minimize heat exposure to the testes—avoid hot tubs, saunas, and prolonged laptop use on the lap, as elevated scrotal temperature impairs spermatogenesis 1.
Consider Sperm Cryopreservation
If ultrasound confirms testicular volume <12 mL or if FSH rises above 12 IU/L, bank sperm immediately—once azoospermia develops, even microsurgical testicular sperm extraction (micro-TESE) only achieves 40-50% sperm retrieval rates 1, 2.
Bank 2-3 separate ejaculates with 2-3 days abstinence between collections—this provides insurance against technical failures, poor post-thaw recovery, or need for multiple treatment attempts 1.
When to Worry: Red Flags Requiring Urgent Evaluation
Testicular Mass or Rapid Atrophy
Palpable testicular mass or rapid testicular shrinkage over weeks to months requires immediate urology referral—testicular cancer presents with firm, painless masses and can cause hormonal changes 2, 3.
Testicular volume <12 mL in men under 30 years with history of cryptorchidism carries >34% risk of intratubular germ cell neoplasia—testicular biopsy is indicated in this specific population 2, 3.
Progressive Hormonal Deterioration
- If repeat testing shows FSH rising above 12 IU/L or testosterone declining below 300 ng/dL, this indicates progressive testicular failure requiring fertility preservation and possible testosterone replacement 1, 2.
Most Likely Explanation
Your perceived testicular changes likely reflect normal physiological variation, measurement subjectivity, or early varicocele rather than true testicular failure—your normal testosterone and sperm production argue strongly against significant pathology 1, 2. However, objective ultrasound measurement and complete hormonal evaluation are essential to confirm this reassuring interpretation and establish a baseline for future monitoring 2, 3.