What does a testicular volume of about 9 mL, normal semen analyses (≈56 million/mL and 43 million/mL) taken seven weeks apart, and an FSH level of 9.9 IU/L (reference 1–12.4) indicate about my testicular function?

Your Testicular Function is Normal Despite Borderline Testicular Volume

Your sperm counts of 56 million/mL and 43 million/mL are well above the WHO reference limit of 16 million/mL and exceed the 40 million/mL threshold associated with optimal fertility, indicating excellent current sperm production despite your testicular volume of 9 mL and FSH of 9.9 IU/L. 1, 2

Understanding Your Current Status

Sperm Production Assessment

• Your sperm concentrations (56 and 43 million/mL) are 3.5 times higher than the WHO lower reference limit and exceed the optimal fertility threshold, confirming robust spermatogenesis 1, 2
• Assuming a typical 3 mL ejaculate volume, your total motile sperm count would be approximately 108-150 million, which vastly exceeds the 10 million threshold associated with good natural conception rates 1, 2
• These sperm counts definitively rule out testicular atrophy or significant testicular dysfunction, as true atrophy produces sperm concentrations below 5 million/mL 2, 3

FSH Level Interpretation

• Your FSH of 9.9 IU/L falls within the normal reference range (1-12.4 IU/L) provided by your laboratory 1
• FSH >7.6 IU/L suggests some degree of testicular compensation—meaning your testes are working harder to maintain normal sperm output—but this threshold applies primarily to men with oligospermia or azoospermia, not to men producing 50+ million sperm/mL 1, 3
• The key protective factor is your actual sperm production: producing 43-56 million/mL demonstrates effective testicular compensation despite the borderline-elevated FSH 1
• FSH levels alone cannot predict fertility status—up to 50% of men with non-obstructive azoospermia and FSH >35 IU/L still have retrievable sperm, so your FSH of 9.9 with excellent sperm counts is reassuring 1, 3

Testicular Volume Context

• Your 9 mL testicular volume is below the typical 12-15 mL threshold, but testicular volume correlates most strongly with FSH levels and sperm quantity, not with absolute fertility potential 4, 5
• Men with testicular volumes of 10-12 mL typically have oligospermia (reduced counts), yet you are producing sperm counts 3-5 times higher than the reference limit 5
• Testicular volumes below 10 mL are typically associated with azoospermia or severe oligospermia (<5 million/mL), which does not apply to your situation 5

What This Pattern Indicates

You have reduced testicular reserve with compensated testicular function. Your testes are smaller than average but are working efficiently to maintain excellent sperm production. The slightly elevated FSH reflects your pituitary gland sending stronger signals to maintain this output 1, 4, 5.

Critical Risk Factors That Could Cause Future Decline

Medications to Absolutely Avoid

• Never use exogenous testosterone or anabolic steroids—these completely suppress FSH and LH through negative feedback, causing azoospermia that can take months to years to recover 1, 3
• Avoid medications that impair spermatogenesis, including certain chemotherapy agents, which can cause severe impairment for up to 2 years following treatment 1

Environmental and Lifestyle Factors

• Minimize heat exposure to the testes (avoid hot tubs, saunas, prolonged laptop use on lap, tight underwear) 1
• Avoid environmental toxins such as lead and cadmium, which contribute to testicular dysfunction 1, 3
• Maintain smoking cessation and healthy body weight (BMI <25), as obesity impairs male fertility 1

Essential Monitoring Strategy

Follow-Up Testing

• Repeat semen analysis in 6 months to establish whether your parameters are stable or declining—this is critical given your reduced testicular reserve 1, 2
• Obtain a complete hormonal panel including LH, total testosterone, and SHBG to calculate free testosterone and fully characterize your hypothalamic-pituitary-testicular axis 1, 3
• If follow-up shows sperm concentration dropping toward 20 million/mL or below, consider sperm cryopreservation (banking 2-3 ejaculates) as insurance against future decline 1

Red Flags Requiring Immediate Action

• Sperm concentration dropping below 20 million/mL on repeat testing 1, 2
• Development of sexual dysfunction or symptoms of hypogonadism (low libido, erectile dysfunction, fatigue) 6, 1
• Any new testicular pain, masses, or changes in testicular consistency 6

When to Seek Specialist Evaluation

• Refer to a male reproductive specialist (urologist or andrologist) if:
  • Follow-up semen analysis shows a declining trend in sperm concentration 1
  • You develop symptoms of hypogonadism despite normal testosterone 1
  • You have a history of cryptorchidism (undescended testicles), which increases risk of testicular pathology 6
  • Physical examination reveals a varicocele, which may be contributing to reduced testicular volume and could benefit from repair 3

Protective Actions to Preserve Fertility

Lifestyle Optimization

• Maintain a diet lower in fats and meats with more fruits and vegetables 1
• Achieve and maintain healthy body weight 1
• Complete smoking cessation if applicable 1
• Minimize scrotal heat exposure 1

Fertility Planning

• If you are planning to have children, do not delay—your reduced testicular reserve means you have less buffer against age-related or environmental decline 1
• Consider sperm cryopreservation now if you anticipate delaying childbearing beyond 2-3 years, as this provides insurance against future decline 1

Common Pitfalls to Avoid

• Do not assume your fertility is impaired based on testicular volume alone—your excellent sperm counts prove otherwise 1, 2, 5
• Do not start testosterone therapy if you desire current or future fertility—this is the single most common iatrogenic cause of male infertility 1, 3
• Do not rely on a single semen analysis—the WHO recommends at least two analyses separated by 2-3 months due to significant intra-individual variability 2
• Do not ignore declining trends—if your next semen analysis shows sperm concentration dropping toward 20 million/mL, act proactively with cryopreservation 1