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Testicular/scrotal changes
Feb 27, 2005

Although a number of guys have submitted questions about shrinking testicles, no one has mentioned their balls losing mass, firmness, and form. Before beginning testosterone replacement therapy, my balls had only slightly shrunk as a result of hypogonadism that resulted in a total free testosterone that ranged 250-350 over a number of years. (In fact, my doctors would regularly comment on my prominent testes.) I have been taking Androgel for nearly a year and half, and over the last several months my testes have not only significantly shrunk but also lost much of their mass, firmness, and form. My urologist is very knowledgeable about re-virilization through testosterone replacement therapy, making sure that both my total and free testosterone levels never go above high normal in the hope that I might be able to maintain my balls as prominent structures even though I no longer produce any endogenous testosterone or sperm.

During my last two visits, my urologist not only noted the reduced size and mushiness of my nuts but also the prominence of the cords (epididymis) and how he could move the testicular mass around in the pouch (tunica) which apparently has not shrunk. Is this a normal result of testicular atrophy? Can anyone predict how much the testes will collapse?

P.S. My urologist also told me that at this point my testes were ruined and would never return to their former size and firmness nor ever be able to produce any significant amounts of testosterone or sperm even if we stopped the TRT).

Response from Dr. Frascino


Your "doctor would regularly comment on your prominent testes???" Really??? I guess I never considered saying, "Hey, look at the size of those humongous thigh slappers!" Well, at least not in the examination room anyway.

OK, on to your questions . . . . "Shrinking testicles" is medically termed testicular atrophy. It involves reduced testicular volume (size) and altered texture ("mushiness"). Can anyone predict the extent of testicular atrophy caused by testosterone replacement therapy (TRT)? No, not really. Will your peanuts ever become walnuts (or in your case, coconuts) again if you stop TRT? Probably not. Your testosterone level was low when you started TRT, and there is no reason to think it would improve spontaneously 1 years later. In fact, you'd probably feel lousy (and limp) if you discontinued your testosterone supplementation. Hypogonadism can be associated with depression, mood disturbance, loss of appetite, inability to maintain or increase lean body mass (muscle and bone), loss of libido, fatigue and reduced quality of life. Consequently, the benefits associated with TRT for hypogonadism generally far outweigh the potential risks.

What should you do about your "not-so-prominent structures" situation? First off, you report a significant change over the past several months. I would suggest you check with an HIV-knowledgeable endocrinologist (or urologist) to see if there is something other than TRT-related testicular atrophy going on. Next, you could discuss with the endocrinologist a trial of anastrozole (or other estrogen blockers) combined with human chorionic gonadotropin and/or Clomid possibly combined with anastrozole. These agents may kick-start the testes into producing testosterone again and thereby possibly increase their "prominence" (testicular volume). To my knowledge this has not been well studied in us poz folks, but I do know it's at least been tried.

Good luck.

Dr. Bob

HIV Prevention

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