Understanding Testicular Size: When to Be Concerned

By Dr. David Samadi

Testicular size varies widely among men; in most cases, small testicles are not a cause for concern. Just like other physical features, testicles come in a range of shapes and sizes. Whether symmetrical or slightly uneven, they’re uniquely individual. However, some men may worry about whether their testicles are too small or too large.

Testicular length is typically measured from top to bottom to assess size, with the average length falling between 4.5 and 5.1 centimeters.

Men with smaller-than-average testicles often wonder if this is normal, while men with average or larger testicles tend to worry less. Small testicles usually don’t indicate significant health problems. However, if testicles appear to shrink over time, it’s worth discussing with a doctor to determine the cause.

Below, we explore some potential reasons for smaller testicles and their treatments.

Possible Causes of Small Testicles

1. Low Testosterone

One common cause of testicular shrinkage is low testosterone. This condition may present with other symptoms such as:

• Decreased libido
• Difficulty achieving or maintaining erections
• Fatigue
• Mood changes, including irritability and depression
• Reduced muscle mass

While some men with low testosterone may notice smaller testicles, this is not always the case. A comprehensive evaluation is needed to identify low testosterone, as symptoms vary from man to man.

Low testosterone requires medical attention to address related health concerns. Men experiencing symptoms should consult their physician for appropriate testing and treatment, which may include testosterone replacement therapy (TRT).

2. Varicocele

A varicocele is when a man has an enlargement of veins within the scrotus, very similar to varicose veins in the legs. This condition affects approximately 40% of men with infertility. Varicoceles may cause one or both testicles to appear smaller.

Treatment for varicoceles typically involves surgery. After surgical correction, testicles often return to their standard size.

3. Congenital Disorders

Certain congenital disorders can lead to smaller testicles. One example is Klinefelter Syndrome, a condition in which a male baby is born with an extra X chromosome (XXY). This occurs in approximately 1 out of every 500–1,000 male births.

Although the condition is not hereditary, it has a slightly higher occurrence in pregnancies after age 35. Physical symptoms of Klinefelter Syndrome include:

• Delayed motor skill development
• Increased abdominal fat
• Smaller testes and penis
• Breast growth during adolescence
• Less body and facial hair
• Reduced muscle tone
• Wider hips and narrower shoulders

There’s no cure for Klinefelter Syndrome, but treatment can alleviate symptoms.

For those with low testosterone levels, supplemental testosterone therapy is often recommended. Working closely with an endocrinologist ensures effective and safe management of hormone levels.

4. Testicular Atrophy

Testicular atrophy refers to the shrinkage of the testicles. Common causes include:

• Aging
• Certain sexually transmitted infections (STIs)
• Viral infections like mumps
• Cirrhosis due to alcohol use
• Complications from inguinal hernia surgery

Treatment depends on the underlying cause. For example, addressing infections or reducing alcohol intake can help prevent further atrophy. Any man noticing unexplained testicular shrinkage should consult a healthcare provider for evaluation.

When to Seek Medical Advice

The size of your testicles alone is rarely a reliable indicator of health issues. However, sudden changes, discomfort, or other symptoms warrant medical attention.

Ask your doctor if you’re concerned about testicular size. Most of the time, there’s no cause for alarm, but understanding the underlying issue—if one exists—can provide peace of mind and, in some cases, lead to effective treatment.

Remember, testicular size varies greatly, and as long as everything functions properly, there’s usually no need for concern.

Dr. David Samadi is the Director of Men’s Health and Urologic Oncology at St. Francis Hospital in Long Island. He’s a renowned and highly successful board certified Urologic Oncologist Expert and Robotic Surgeon in New York City, regarded as one of the leading prostate surgeons in the U.S., with a vast expertise in prostate cancer treatment and Robotic-Assisted Laparoscopic Prostatectomy.  Dr. Samadi is a medical contributor to NewsMax TV and is also the author of Prostate Cancer, Now What? At Practical Guide to Diagnosis, Treatment, and Recovery, and The Ultimate MANual, Dr. Samadi’s Guide to Men’s Health and Wellness, available online both on Amazon and Barnes & Noble. Visit Dr. Samadi’s websites at robotic oncolo gy and prostate cancer 911.