Assessment of Testicular Atrophy
Based on your clinical presentation—decreased testicular size, elevated FSH (>7.6 IU/L), elevated LH, and low sperm count/motility—you do have testicular atrophy, which indicates primary testicular dysfunction with impaired spermatogenesis. 1
Understanding Your Diagnosis
Your hormone profile and testicular measurements are consistent with testicular atrophy and non-obstructive causes of reduced fertility:
- Testicular volumes less than 12 ml are definitively considered atrophic and associated with impaired spermatogenesis 2
- Elevated FSH levels (>7.6 IU/L) strongly suggest non-obstructive azoospermia or severe oligospermia when accompanied by testicular atrophy 1
- The combination of small testes, elevated FSH, and elevated LH indicates primary testicular failure, meaning your testes are not responding adequately to hormonal signals 1
- Testicular volume strongly correlates with total sperm count and sperm concentration, so smaller volumes predict lower sperm parameters 3
What This Means for Sperm Production
Despite having testicular atrophy, complete absence of sperm is not guaranteed:
- Up to 50% of men with non-obstructive azoospermia and elevated FSH still have retrievable sperm via microsurgical testicular sperm extraction (micro-TESE) 1
- Men with testicular volumes of 10-12 ml typically have oligospermia rather than complete azoospermia, with FSH >7.6 IU/L indicating impaired but not necessarily absent spermatogenesis 1, 2
- FSH levels alone cannot definitively predict fertility status—actual sperm production must be assessed through semen analysis 1
Critical Next Steps
Essential Testing:
- Perform at least two semen analyses separated by 2-3 months to confirm your actual sperm production, as single analyses can be misleading 1
- Obtain complete hormonal panel including LH and total testosterone to fully characterize your hypothalamic-pituitary-testicular axis 1
- If sperm concentration is <5 million/mL, obtain karyotype analysis and Y-chromosome microdeletion testing (AZFa, AZFb, AZFc regions), as complete AZFa and AZFb deletions predict near-zero sperm retrieval success 1
Fertility Preservation:
- Consider sperm cryopreservation immediately if any sperm are present, banking 2-3 separate ejaculates, as testicular atrophy carries risk of progressive spermatogenic failure 1
- Once azoospermia develops, even micro-TESE only achieves 40-50% sperm retrieval rates, making preservation of existing sperm critical 1
Critical Warnings
Never use exogenous testosterone therapy if fertility is desired, as it will completely suppress spermatogenesis through negative feedback on the hypothalamus and pituitary, potentially causing azoospermia that can take months to years to recover 1, 4, 5