I’m an adult male with bilateral testicular volume of 9 ml (low), normal follicle‑stimulating hormone, normal sperm concentration, and an asymptomatic right‑sided varicocele—should I be concerned about testicular atrophy?

Assessment of Testicular Volume and Fertility Status

Your testicular volume of 9 ml bilaterally is below the normal threshold and represents testicular atrophy, but your normal sperm count of 56 million/ml and FSH of 9.9 IU/L (within normal range) indicate that you currently have adequate sperm production and are not at immediate risk of infertility. 1, 2, 3

Understanding Your Current Status

Your situation represents a pattern of compensated testicular dysfunction—your testes are smaller than normal (12 ml is the lower limit of normal), but they are still producing sperm effectively 2, 4. This is confirmed by:

• Testicular volume of 9 ml: This is definitively below the 12 ml threshold that defines normal testicular size, placing you in the atrophic range 1, 2
• FSH of 9.9 IU/L: While in the upper portion of the normal range (1-12.4 IU/L), this is still below the 7.6 IU/L threshold that strongly predicts non-obstructive azoospermia 1, 3
• Sperm count of 56 million/ml: This exceeds the WHO lower reference limit of 16 million/ml by more than 3-fold, confirming normal sperm production 1, 4

Research has documented cases of men with elevated FSH and even testicular atrophy who maintain normal fertility—these represent compensated primary testicular disease where normal sperm production is maintained despite underlying testicular stress 5.

Role of Your Right-Sided Varicocele

Your non-clinical (subclinical) right varicocele is unlikely to be the primary cause of your testicular atrophy:

• The AUA/ASRM guidelines explicitly state that treatment of subclinical varicoceles found only on ultrasound is not helpful and should not be performed 6
• Varicoceles do cause ipsilateral testicular atrophy in many men, but studies have failed to demonstrate a correlation between testicular volume loss and actual fertility status in men with varicoceles 7
• Your varicocele is right-sided and non-clinical (not palpable), which makes it even less likely to be clinically significant 6

Do not pursue treatment of your subclinical varicocele—the guidelines are clear that only palpable (clinical) varicoceles with documented abnormal semen parameters warrant repair 6, 8.

What Likely Explains Your Small Testicular Volume

Several factors can cause reduced testicular volume while maintaining adequate sperm production:

• History of cryptorchidism (undescended testicles): Even after surgical correction, testes often remain smaller than normal 2, 8
• Prior testicular injury or infection: Orchitis or trauma can cause permanent volume loss 5
• Genetic factors: Some men have constitutionally smaller testes that still function adequately 4
• Metabolic or hormonal factors: Thyroid dysfunction, obesity, or other systemic conditions can affect testicular size 1

Critical Actions to Protect Your Fertility

1. Obtain Complete Hormonal Evaluation

Measure the following on two separate morning samples (8-10 AM) 1, 8:

• LH and total testosterone (to distinguish primary vs. secondary testicular dysfunction)
• Prolactin (to exclude hyperprolactinemia)
• Thyroid function (TSH, free T4)
• SHBG to calculate free testosterone

This will clarify whether your testicular atrophy represents isolated seminiferous tubule dysfunction or broader testicular failure 1, 8.

2. Repeat Semen Analysis in 3-6 Months

Single semen analyses can be misleading due to natural variability 1, 8. You need serial measurements to establish whether your parameters are stable or declining 1.

3. Consider Sperm Cryopreservation NOW

This is your most important protective action. Men with reduced testicular reserve (volume <12 ml) are at risk for progressive spermatogenic failure 1, 8. The AUA/ASRM strongly recommends banking sperm—preferably 2-3 separate ejaculates—to preserve fertility options 1, 8:

• Once azoospermia develops, even microsurgical testicular sperm extraction (micro-TESE) only achieves 40-50% sperm retrieval rates 1
• Banking multiple samples provides insurance against technical failures or poor post-thaw recovery 1
• Your current sperm count of 56 million/ml is excellent for cryopreservation 1

4. Avoid All Gonadotoxic Exposures

• Never use exogenous testosterone or anabolic steroids—these will completely suppress your sperm production through negative feedback and can cause azoospermia that takes months to years to recover 1, 8
• Avoid excessive heat exposure to the testes (hot tubs, saunas, laptop use on lap) 1
• Maintain healthy body weight (BMI <25) 1
• Smoking cessation if applicable 1

Monitoring Protocol

Establish the following surveillance schedule 1, 8:

• Semen analysis every 6-12 months to detect early decline
• Hormonal panel (FSH, LH, testosterone) annually or sooner if sperm parameters decline
• Physical examination to monitor for testicular size changes or development of palpable varicocele
• Immediate evaluation if you develop: rapid testicular atrophy, palpable testicular mass, or severe oligospermia (<5 million/ml)

When to Seek Specialist Referral

Consult a male reproductive specialist (urologist or reproductive endocrinologist) if 1, 8:

• Sperm concentration drops below 20 million/ml on repeat analysis
• FSH rises above 12 IU/L
• You develop symptoms of testosterone deficiency (low libido, erectile dysfunction, fatigue)
• You have a history of cryptorchidism (this substantially increases testicular cancer risk and warrants closer surveillance) 2, 8

Reassuring Points

• Your current fertility status is normal—sperm count of 56 million/ml places you well within the fertile range 1, 4
• FSH of 9.9 IU/L, while upper-normal, is not predictive of imminent testicular failure 1, 5
• Research confirms that testicular volume of 9 ml can still yield successful sperm retrieval in 93.8% of cases if intervention becomes necessary 3
• Many men with compensated testicular dysfunction maintain stable fertility for years or decades 5

Common Pitfalls to Avoid

• Do not pursue varicocele repair for your subclinical right varicocele—this will not improve your testicular volume and is not indicated 6, 8
• Do not start testosterone replacement if you desire current or future fertility—this is the single most common iatrogenic cause of azoospermia 1, 8
• Do not delay sperm banking if you are concerned about future fertility—once parameters decline, retrieval becomes much more difficult 1, 8

Your immediate priority should be sperm cryopreservation to protect your fertility options, followed by complete hormonal evaluation to identify any reversible causes of your reduced testicular volume. 1, 8