Testicular atrophy is when the testicles shrink. The tissue changes, including the seminiferous tubules. When that happens, the testicles get smaller.
The causes of testicular atrophy are varied. Understanding the testicular atrophy pathology — what’s happening in the tissue — is important because early intervention can sometimes reverse the atrophy.
In this article, we’ll cover the definition, causes, diagnosis, microscopic appearance, differential diagnosis, and treatment of testicular atrophy.
Causes and Risk Factors
A number of things can lead to testicular atrophy.
Medical Conditions and Infections
Infections sometimes can cause the testicles to shrink.
Mumps, orchitis, and HIV are a few of the infections that may cause testicular atrophy.
Testicular torsion is a critical condition that can cause atrophy. Testicular torsion happens when the spermatic cord gets twisted, cutting off the testicle’s blood supply. It’s a serious problem that requires immediate medical care.
Varicocele may also affect testicular size. Varicocele is a condition in which the veins in the scrotum become enlarged. It often affects the left testicle.
Lifestyle Factors
Consuming too much alcohol may damage testicular tissue.
The aging process can also contribute to testicular atrophy, as natural processes may cause some shrinkage.
Other Causes
Hormone imbalances, like low testosterone, can cause atrophy.
Testicular cancer, while rare, can also cause the testicles to shrink.
Cryptorchidism is another condition often associated with atrophy.
Diagnosing Testicular Atrophy
Diagnosing testicular atrophy usually involves a few steps:
- Physical Exam: Your doctor will check the size, shape, and feel of your testicles. It’s helpful if you know what’s normal for you.
- Imaging: An ultrasound might be used to get a better look.
- Lab Tests: Blood work, hormone tests, and possibly STI tests might be ordered to check for underlying issues.
If you notice one or both of your testicles are getting smaller, see a doctor ASAP. And definitely get checked out if you suspect you have any other medical condition that might be causing it.
Microscopic and Gross Appearance
When pathologists examine the testes, they look for certain things that might indicate atrophy.
Gross Appearance
The first thing that’s apparent is that the atrophic testis is smaller than it should be. It’s decreased in size.
Microscopic Features
When examining the tissue under a microscope, pathologists look for changes in the seminiferous tubules, which are responsible for sperm production. These changes include:
- Thickening of the basement membrane, which surrounds the tubules.
- Intertubular fibrosis, which is scarring between the tubules.
- A decrease in the number of sperm cells, or a complete absence of sperm.
Sertoli cells, which support sperm development, may contain eosinophilic granules (structures that stain pink with eosin dye). However, this isn’t a sign specific to atrophy.
In rare cases, spermatids (immature sperm cells) might still be found in atrophic testes, but overall sperm production is significantly reduced.
Differential Diagnosis
When a pathologist examines testicular tissue, they need to rule out other possible conditions that might look similar to atrophy. These include:
- Sertoli cell nodules
- Testicular scars
- Germ cell neoplasia in situ (though atrophic testicles will test negative for this)
- Seminoma, particularly when growing between tubules, rather than in a mass. Seminomas that only grow between the tubules must be excluded.
Treatment and Prognosis
Treatment for testicular atrophy depends on what’s causing it. You might need antibiotics, lifestyle changes, or hormone therapy, and in some cases, testosterone replacement therapy using auto-injectors may be considered. Surgery might be required, particularly if it’s related to long-standing cryptorchidism, where the testicle hasn’t descended properly.
The good news is that the prognosis is usually good. Getting treatment early improves the outcome, so don’t delay seeing a doctor if you notice changes.
Frequently Asked Questions
Can testicular atrophy be caused by hydrocele?
While a hydrocele itself doesn’t directly cause atrophy, a very large and long-standing hydrocele can potentially contribute to testicular atrophy. The increased pressure and impaired blood flow caused by a significant hydrocele could theoretically lead to a decrease in testicular size over time, but this is not the typical or primary cause of atrophy.
Is hypoplasia the same as atrophy?
No, hypoplasia and atrophy are distinct. Hypoplasia refers to incomplete development of a tissue or organ from birth, resulting in a smaller size than normal from the outset. Atrophy, on the other hand, is the shrinkage of a tissue or organ that was previously of normal size. So, hypoplasia is a developmental issue, while atrophy is a reduction in size after normal development.
What drugs cause testicular atrophy?
Several drugs can potentially cause testicular atrophy as a side effect. Anabolic steroids are a well-known culprit, as they suppress the body’s natural testosterone production, which can affect metabolism. Other drugs include certain antiandrogens (used to treat prostate cancer), some chemotherapy drugs, and prolonged use of opioids. It’s essential to discuss potential side effects with your doctor before starting any new medication.
Why is my testicle hard as a rock?
A testicle that feels unusually hard should always be evaluated by a doctor. Hardness can be a sign of several conditions, including testicular torsion, infection (orchitis), hydrocele, spermatocele, or, in some cases, testicular cancer. Self-examination is important, but it’s not a substitute for professional medical advice.
What are the tumor markers for seminomas?
Seminomas, a type of testicular cancer, often produce elevated levels of certain tumor markers. The most commonly used marker is placental alkaline phosphatase (PLAP). Beta-human chorionic gonadotropin (β-hCG) can also be elevated in some seminomas, although usually at lower levels than in non-seminomatous germ cell tumors. Alpha-fetoprotein (AFP) is typically not elevated in pure seminomas; if AFP is high, it suggests the presence of non-seminomatous elements.
Summary
Testicular atrophy is when your testicles shrink. If you notice this happening, it’s important to seek medical care as soon as possible. The earlier you receive treatment, the better the chances of reversing the atrophy.
Regular testicular self-exams are a good idea, and if you have any concerns, it’s important to talk with your doctor right away.