Understanding Testicular Atrophy and Hormone Disruption: Impact of Steroids and Testosterone Replacement Therapy (TRT)

December 6, 2023

"Navigating Hormonal Disruption: Effects of Steroids and TRT on Testicular Health"

"Decoding Testicular Changes: TRT and Testicular Size"

When individuals take anabolic steroids or exogenous testosterone injections, gels or patches, for performance enhancement or testosterone replacement therapy (TRT), the body's natural hormonal balance is disrupted. The testes, responsible for producing testosterone, respond to this external addition of hormones by decreasing their own production of testosterone. Men on testosterone therapy typically are prescribed a gel or cream, patch or injectable testosterone cypionate or enanthate. Some men who take performance enhancing anabolic steroids can take more that one form of synthetic (non bio-identical) anabolic drugs.  Steroids are a class of compounds, and within this category, there are various types. Some popular anabolic-androgenic steroids (AAS), which are often associated with performance enhancement and muscle growth, include:

1.     Testosterone: The primary male sex hormone and the foundation for many other synthetic steroids. Variants include testosterone enanthate, testosterone cypionate, testosterone propionate, etc.

2.     Nandrolone: Examples include Deca-Durabolin (nandrolone decanoate) and Durabolin (nandrolone phenylpropionate).

3.     Stanozolol: Commonly known by the brand name Winstrol.

4.     Oxandrolone: Known by the brand name Anavar.

5.     Methandrostenolone: Often referred to as Dianabol.

6.     Trenbolone: Variants include trenbolone acetate and trenbolone enanthate.

These substances are often subject to legal restrictions and are prohibited in many sports and competitions due to their potential for misuse, side effects, and health risks. It's crucial to note that using steroids without proper medical guidance can pose serious health risks and side effects. Testicular atrophy is a very common side effect of these medications.

"Why Do My Nuts Shrink on TRT?"

The body has a complex system of checks and balances to maintain hormone levels within a certain range. When an individual introduces exogenous testosterone (steroids) into the body, the hypothalamus region of the brain detects higher-than-normal testosterone levels. In response, the brain signals the testes to reduce their natural production of testosterone. This is a mechanism known as negative feedback regulation. The hypothalamus decreases thesecretion of gonadotropic releasing hormone (GnRH) and this in turn suppresses the secretion of two very important gonadotropins. Luteinizing hormone and follicle stimulating hormone (LH and FSH). In men, these hormones play crucial roles in the regulation of the reproductive system and the production of sex hormones.

  1. Luteinizing Hormone (LH):
  • In men, LH stimulates the Leydig cells in the testes to produce testosterone, the primary male sex hormone. It controls the rate of testosterone synthesis and secretion.
  • LH also plays a role in the maturation of sperm cells within the testes by supporting the function of Leydig cells, which indirectly affects sperm production.

  1. Follicle-Stimulating Hormone (FSH):
  • FSH is essential for spermatogenesis, the process by which immature sperm cells (spermatogonia) develop into mature sperm cells (spermatozoa).
  • FSH stimulates the Sertoli cells in the testes, which support and nourish developing sperm cells, providing nutrients and creating the proper environment for sperm maturation.

Both LH and FSH work in coordination to regulate the testes' functions in producing testosterone and supporting sperm production. Proper levels and functioning of these hormones are vital for maintaining reproductive health and fertility in men. Changes or imbalances in LH and FSH levels can impact testosterone production and sperm development, potentially leading to fertility issues or hormonal imbalances.

The decreased production of testosterone by the testes due to the presence of external hormones can cause testicular atrophy, which refers to the shrinking of the testes. Since the testes are producing less testosterone themselves, they may decrease in size. So when men ask “Will my balls shrink if I take testosterone?” the answer could be yes. Not everyone responds the same way to treatments, however it is a side effect of taking testosterone.

Will My Balls Return to Normal if I Stop Testosterone?

It's important to note that while testicular atrophy might occur temporarily during steroid use, in many cases, the testes can regain their normal size once the use of exogenous hormones is discontinued, allowing natural testosterone production to resume. However, the recovery of testicularsize and function may take some time after stopping steroid use or TRT. Another popular option to help maintain testicular function when taking exogenous testosteroneis the use of hCG, clomid or enclomiphene. Some clinics even prescribe Gonadorelin for this purpose. These drugs can help maintain both size of the testes as well as maintain fertility. There are benefits and potential risks associated with allmedication so it’s important to consult with your doctor to see what options may be best suited for your unique medical needs. There are many clinics that can prescribe hCG for men on testosterone, however the supply of hCG is low and the demand is high as it is a very effective medication.

What Happens to My Hormone Levels if I Take Testosterone?

This phenomenon highlights the body's attempt to maintainhormonal balance but underscores the potential consequences of using external hormones, including the impact on natural hormone production and the associatedchanges in organ size and function. Other potential issues can arise such as an increase in estrogen levels due to aromatization, the biochemical process where androgens are converted into estrogens specifically estradiol, through theaction of the enzyme aromatase. This conversion occurs mainly in adipose tissue (body fat) and in the testes.

In males, a small amount of testosterone naturally converts into estrogen to maintain a hormonal balance. However, excessive aromatization can occur due to various factors such as steroid use, excess body fat or certain medications. Aromatization can have significant effects, especially in men, leading to imbalances in hormone levels. Excess estrogen in males can cause symptoms such as gynecomastia (enlargement of breast tissue), water retention, and mood changes. In some cases, it can also contribute to reduced fertility and other health issues. Men on TRT typically will not see estradiol levels rise to dangerous levels but its always a good idea to monitor and blood markers that may shed light on your hormonal balance while on any form of HRT. A simple blood test can help provide your doctor valuable information and help make any needed adjustments in your protocol to alleviate and signs or symptoms of sub-optimal hormone levels.

The article delves into the impacts of anabolic steroids and testosterone replacement therapy (TRT) on testicular health, emphasizing changes in testicular size and hormone regulation. Anabolic steroids and exogenous testosterone administered for performance enhancement or TRT disrupt the body's natural hormonal balance. Testosterone therapy usually involves creams, gels, patches, or injectable testosterone cypionate/enanthate, while steroid users may employ multiple synthetic anabolic compounds, including testosterone variants, nandrolone, stanozolol, oxandrolone, methandrostenolone, and trenbolone. Despite their muscle-building potential, these substances carry legal restrictions, health risks, and side effects, prominently testicular atrophy.


*NovaGenix neither supports, or assists in the prescription of anabolic steroids or other non-bio-identical compounds for performance enhancement. We strictly adhere to all FDA regulations regarding the utilization of testosterone for TRT for patients who qualify medically.


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Blood Work Request Form

This subsequent lab panel is necessary for males undergoing Testosterone Replacement Therapy (TRT) through NovaGenix Health and Wellness. It allows physicians to assess the patient's response to prescribed medications, covering sex hormone levels, thyroid function, adrenal health, hematocrit, and liver and kidney function. The panel includes tests such as:

  • Complete Blood Count
  • Comprehensive Metabolic Panel
  • Testosterone (Free and Total)
  • Estradiol Sensitive
  • Thyroid Stimulating Hormone
  • Prostate Specific Antigen

Each test serves a specific purpose in monitoring overall health and treatment effectiveness. When required, Dr Mackey may require LH and FSH (Luteinizing hormone, follicle stimulating hormone) SHBG (Sex hormone binding globulin) or any other tests which may be important for your health and optimizing your hormones.

The Comprehensive Hormone and Wellness Panel for Women offers a foundational assessment of sex hormones, thyroid function, adrenal health, metabolic activity, and overall well-being. This panel serves as a diagnostic tool for identifying testosterone and estrogen deficiencies, assessing health risks, and detecting potential thyroid issues before considering hormone replacement therapy. Additionally, it includes insights into hematocrit (red blood cell volume), as well as liver and kidney function. The panel encompasses various tests such as:

  • Complete Blood Count (CBC)
  • Complete Metabolic Panel
  • Testosterone (free and total)
  • Estradiol
  • Thyroid Stimulating Hormone (TSH)
  • Progesterone

When indicated, Dr. Mackey may require additional tests such as Follicle Stimulating Hormone (FSH), and IGF-1 and Cortisol.

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