Given bilateral testicular volume of 10 ml, follicle‑stimulating hormone at the upper limit of normal, elevated testosterone, and normal sperm concentration, is testicular atrophy likely?

Testicular Atrophy Assessment

Based on your testicular volume of 10ml bilaterally, FSH at the upper limit of normal (9.6 IU/L), elevated testosterone (40 nmol/L), and normal sperm count (56 million/ml), you do NOT have clinically significant testicular atrophy that is impairing your fertility. Your parameters indicate compensated testicular function with preserved spermatogenesis.

Understanding Your Testicular Volume

Your 10ml bilateral testicular volume falls just below the 12ml threshold that defines testicular atrophy, but this must be interpreted in the context of your preserved fertility parameters. 1

• Testicular volumes less than 12ml are generally considered small or atrophic and warrant further investigation, particularly when associated with impaired spermatogenesis 1
• However, the 12ml cutoff is most clinically significant when accompanied by elevated FSH AND reduced sperm production 2
• In men under 30-40 years with testicular volume <12ml and testicular cancer, there is a ≥34% risk of intratubular germ cell neoplasia in the contralateral testis, making this threshold critical in oncology settings 2, 1

Your situation differs critically because your sperm count of 56 million/ml far exceeds the WHO lower reference limit of 16 million/ml, indicating that your testes are functioning adequately despite their borderline size. 1

Interpreting Your Hormone Profile

Your FSH of 9.6 IU/L (upper limit of normal) combined with elevated testosterone suggests compensated primary testicular function—your pituitary is working harder to maintain normal sperm production, and it's succeeding. 3

• FSH levels >7.5 IU/L are associated with a five- to thirteen-fold higher risk of abnormal sperm concentration compared to FSH <2.8 IU/L 4
• However, elevated FSH with normal sperm counts represents "compensated testicular disease"—normal fertility maintained at the expense of chronically elevated FSH 3
• Your testosterone of 40 nmol/L (approximately 1154 ng/dL) is elevated, indicating robust Leydig cell function and arguing strongly against primary testicular failure 1

This pattern indicates reduced testicular reserve rather than testicular atrophy with impaired function. You have less capacity to compensate if additional stressors occur (varicocele, infection, medications), but your current fertility is preserved. 1

Clinical Significance of Your Sperm Count

Your sperm concentration of 56 million/ml is 3.5 times higher than the WHO lower reference limit and indicates normal spermatogenesis despite borderline testicular size. 1

• The WHO lower reference limit for sperm concentration is 16 million/ml 1
• Men with non-obstructive azoospermia typically present with testicular atrophy (volume <12ml), elevated FSH (typically >7.6 IU/L), and absent or severely reduced sperm production 5
• Your preserved sperm count definitively excludes non-obstructive azoospermia and indicates that your seminiferous tubules are functioning adequately 5

What This Means for You

You have borderline-small testes with compensated function—not testicular atrophy in the clinical sense that impairs fertility. The key distinction is:

• True testicular atrophy = small testes + elevated FSH + impaired sperm production (oligospermia or azoospermia) 2, 1
• Your situation = borderline-small testes + upper-normal FSH + normal sperm production = compensated testicular function 3

Important Caveats and Monitoring

While you don't have clinically significant atrophy now, your reduced testicular reserve warrants monitoring and protective actions:

Risk Factors to Avoid:

• Never use exogenous testosterone or anabolic steroids—these will completely suppress FSH and LH through negative feedback, causing azoospermia that can take months to years to recover 1, 5
• Avoid gonadotoxic medications, excessive heat exposure to the testes, and maintain healthy body weight (BMI <25) 1
• Smoking cessation and minimizing environmental toxin exposure are protective 5

Monitoring Recommendations:

• Repeat semen analysis every 6-12 months to detect early decline in sperm parameters, as single analyses can be misleading due to natural variability 1
• If sperm concentration drops below 20 million/ml or shows a declining trend, strongly consider sperm cryopreservation (banking 2-3 ejaculates) before parameters worsen further 1
• Measure complete hormonal panel (FSH, LH, testosterone, SHBG) if sperm parameters decline 1

When to Seek Further Evaluation:

• Development of palpable testicular mass 2
• Rapid testicular atrophy or size discrepancy >2ml between testes 1
• Sperm concentration dropping below 5 million/ml—this would warrant karyotype analysis and Y-chromosome microdeletion testing 1, 5
• If you have a history of cryptorchidism (undescended testicles), this substantially increases cancer risk and mandates closer surveillance 2, 1

Fertility Considerations:

• Your current fertility potential is good—sperm count of 56 million/ml provides excellent natural conception probability 1
• If planning future children, don't delay unnecessarily given your reduced testicular reserve 1
• Female partner age is the most critical factor determining conception success 1

The bottom line: You have borderline-small testes with preserved fertility function. This is not testicular atrophy in the clinical sense, but it does indicate reduced reserve that requires monitoring and protective lifestyle measures. 1, 3