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Sizing Up the Issue

Sizing Up the Issue

Are My Testicles Normal?

I was born with a right undescended testicle and was operated on as a 2-year old. I noticed that that this right testis is very small even though it does not cause me any problems. Should I be concerned at all?

I am in love with this wonderful woman and plan to get married soon. However, I was born with two tiny testicles. They are the size of peas and I am too embarrassed to tell her. I am also worried about my fertility. I desperately need your advice.

Recently my spouse noticed that my left testicle seems to be bigger than my right testicle. It also feels harder but is somehow painless. Is there something I need to know?

These are the questions I hear from time to time at my clinic from patients who worry about the size of their testicles. It’s not unusual to have these concerns if you suspect there are irregularities as after all, these are part and parcel of a man’s crown jewels.

DidYouKnow >>>> Although size isn’t everything when it comes to the male organ as a whole, when it comes to the testis, it can tell you if something needs attention.

Irregularities

The testis serves important functions such as testosterone (male hormone) production as well as sperm manufacturing. While there’s nothing uncommon about men having one testicle that is slightly bigger or hanging lower than the other, it is important to identify hidden conditions which may need further scrutiny. Getting down to the root of the problem, if there is any, is crucial to ensure that patients get the best outcomes.

I usually tell patients with irregular testicle sizes that the issue needs to be narrowed down to the duration of the irregularity as well as the associated symptoms.

There are people born with small testicles, while in some cases it could be due to underlying hormonal malfunction or genetically linked disorders. There are also others who acquired the condition through drug use/abuse, alcoholism, trauma to the testis or misdiagnosed torsion testis, all of which eventually led to small atrophied testicles. Men with congenital small testicles may present with infertility problem due to the defective cells in the testis which contribute to low sperm production. They may also experience an impact on the development of secondary male characteristics such as muscle growth, the deepening of the voice and the growth of facial hair. Conversely, bodybuilders who abuse testosterone to beef themselves up may end up with testicular shrinkage due to the inhibition of male hormone production within their testicles.

In the case of bilaterally undescended testicles, if they are not surgically corrected, they often result in small testicles that not only lead to infertility but also gear towards malignancy later in life.

On the other hand, a gradual increment of the scrotum size does not necessarily mean that the testicle has increased in size too. Depending on the associated signs and symptoms, it could be caused by hernia, fluid collection around the testicle (hydrocele), swollen veins in the testicle (varicocele), blood clots around the testis post trauma, infection of the testicle or even testicular cancer. Just like breast cancer, self-examinations of the testicle is imperative to rule out cancer.

Other than irregular sizes, the lump and hard consistency of the testis should also warrant further investigations. Even though testicular cancer is found in all ages, it tends to be found in the younger age group. It is thus vital to create public awareness of this often less talked about medical condition. An infection of the testis can be treated quite easily with antibiotics, but hernia, hydrocele or varicocele may require surgical intervention.

Meanwhile, patients with torsion (twisted) testis presented with testicular pain can be misdiagnosed as infection as they often have similar symptoms. Instead of providing immediate surgical intervention to untwist the testicle, some patients may instead be given antibiotics and pain killers. Symptoms may subside after some time but the patient will end up with small dead testis.

Clear Any Doubt

Back to the typical questions raised by patients above:

A: Insults to the testis could have happened whilst the testis was in the abdominal cavity due to the higher temperature there. This could result in smaller testis. It should be surgically corrected at an early age to prevent malignant transformation. When the testis is fixated at the scrotum, it will be easier for the patient to perform self-examinations.

B: Tiny testicles, if the size falls below average, may result in infertility. Nonetheless, a semen analysis should be performed to confirm it. Depending on the quality of sperm, artificial insemination can be offered as a solution for couples who wish to start a family. On the other hand, normal testicular size does not guarantee fertility. Tight underwear or regular visits to the steam room or sauna may affect the fertility as insult of testicle occurs with constant heating.

C: Painless hard lumps in the testis should never be ignored as they may signify malignancy.

So, size does matter when it comes to the testis as it may indicate underlying issues. It is important to seek medical attention to clear any doubt that you may have.

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