Why have my testes stopped elevating during erection and now appear small?

Testicular Elevation During Erection and Small Testicular Size

Your testes have likely stopped elevating during erection due to age-related changes in the cremasteric reflex, which naturally varies throughout life and peaks between ages 5-8 years before declining; the small appearance warrants urgent evaluation for testicular atrophy, which requires measurement with an orchidometer or ultrasound and hormonal assessment to rule out serious underlying conditions affecting fertility and overall health.

Understanding Normal Testicular Elevation During Erection

The elevation of testes during erection occurs through a reflex mechanism called the "peno-cremasteric reflex," where the cremasteric muscle contracts in response to penile erection 1. This is a normal physiological response that:

• Involves momentary cremasteric muscle contraction with electrical activity increasing from baseline 74.8 microV to 486.6 microV during erection 1
• Functions through a spinal reflex pathway that can be activated by penile stimulation 1
• Varies significantly with age, with the highest activity occurring between ages 5-8 years (75.2% positive bilateral response), then declining in adolescence and adulthood 2

The absence or reduction of this reflex in adulthood is often a normal age-related change and does not necessarily indicate pathology 2.

Critical Concern: Small Testicular Size

The more concerning aspect of your presentation is the small appearance of your testes, which requires immediate evaluation:

Defining Testicular Atrophy

• Testicular volume <12 mL is considered small or atrophic and is associated with impaired sperm production 3
• Normal adult testicular volume ranges from 15-25 mL 3

Immediate Diagnostic Steps Required

You need precise measurement of testicular size using either:

• Prader orchidometer (physical examination tool) 3
• Scrotal ultrasound for accurate volume measurement 3

Complete hormonal evaluation must include 3:

• FSH (most important - levels >7.6 IU/L indicate testicular dysfunction even if within "normal" lab range) 3
• LH
• Total testosterone
• SHBG
• Prolactin

Semen analysis is essential 3:

• At least two analyses separated by 2-3 months 3
• Testicular size directly predicts sperm production capacity 3

Common Causes of Small Testes

Varicocele 3:

• Can cause testicular atrophy with normal hormone levels
• Correction may improve both size and fertility

History of undescended testes (cryptorchidism) 4, 3, 5:

• Even after successful childhood surgery, testes may remain smaller
• Carries 2.75-8 times higher lifetime risk of testicular cancer 5
• Associated with reduced fertility potential 5

Primary testicular dysfunction 6, 3:

• May require karyotype testing if sperm concentration is abnormal
• Y-chromosome microdeletion testing may be indicated 6

Critical Red Flags Requiring Urgent Specialist Referral

If you have history of cryptorchidism AND testicular volume <12 mL 3:

• 34% risk of precancerous changes (intratubular germ cell neoplasia)

• May require testicular biopsy, particularly if under age 30 3

If both testes are very small with elevated FSH 6:

• Suggests primary testicular failure
• Requires genetic testing for Klinefelter syndrome or other chromosomal abnormalities 6

Cardiovascular Health Consideration

Any erectile changes, including altered sensation or function, should prompt cardiovascular risk assessment 6:

• Erectile dysfunction is a risk marker for underlying cardiovascular disease 6
• Morning serum total testosterone should be measured 6
• Consider evaluation for diabetes, hypertension, and lipid disorders 6

Recommended Action Plan

1. Schedule appointment with urologist immediately for 3:

   • Precise testicular volume measurement
   • Complete hormonal panel (especially FSH)
   • Semen analysis (two samples, 2-3 months apart)

2. Do NOT order imaging yourself - let the specialist determine if scrotal ultrasound is needed based on physical examination 3

3. Provide complete history including 6, 4, 5:

   • Any childhood testicular problems or surgeries
   • Onset and progression of size changes
   • Any associated symptoms (pain, swelling, lumps)
   • Fertility concerns or plans

4. If testicular volume confirmed <12 mL, expect 6, 3:

   • Possible genetic testing (karyotype, Y-chromosome microdeletions)
   • Fertility counseling
   • Long-term surveillance plan

Common Pitfalls to Avoid

• Do not assume small testes are "normal for you" - objective measurement is essential 3
• Do not ignore this as purely cosmetic - testicular atrophy indicates potential fertility impairment and may signal systemic health issues 6, 3
• Do not delay evaluation - if related to treatable causes like varicocele, earlier intervention preserves more testicular function 3