Testicular Atrophy for Men on Testosterone Replacement Therapy

When it comes to managing the side effects from taking prescription testosterone, an experienced doctor should be able to explain all the risks and benefits to their patients. One of the more common side effects (and fortunately an easily treatable one) would be testicular atrophy. It is often one of the first questions that patients inquiring about beginning TRT asked us.  “Doc, will my balls shrink on testosterone?” It’s a legitimate concern for patients and a subject we’ll discuss in this blog article.

Why do testicles shrink when men take steroids?    

Men on testosterone replacement therapy often experience testicular atrophy because the use of exogenous testosterone cypionate. All steroids, especially anabolic steroids, can disrupt the body's natural hormone production. Steroids can suppress the natural production of testosterone, the male sex hormone, in the testes. When the body senses an excess of testosterone in the blood stream (due to external testosterone/steroid use), it can signal the testes to produce less testosterone, leading to testicular atrophy or shrinkage. We call this a negative feedback signal. Different from when the body experiences a lower level of testosterone, which would cause the release of hormones to signal natural testosterone production, which is a positive feedback signal. The body usually stays within very predictable ranges innate to the individual. Some men have higher levels, some have lower natural levels. What you don’t typically see is huge fluctuations unless there is some underlying medical reason.

     When it comes to the negative feedback cycle and testicular atrophy, this is a reversible side effect once steroid use is discontinued, but it may take some time for the testicles to return to their normal size and for natural hormone production to resume. It's essential to note that steroid use can have other adverse health effects as well which may vary from person to person especially when not being prescribed and monitored by a licensed and experienced physician. Testosterone Therapy is however different in nature and protocol than the use of steroids for performance enhancing purposes. A lower dose designed to keep men within normal ranges will have a less dramatic impact on testicular atrophy but there may be some noticeable size change. Fortunately, this can be addressed by an experienced physician.

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It does make sense to discuss the basic understanding we have of the neuroendocrine control of the hypothalamo-pituitary–gonadal axis. In 1955 Geoffrey Harris wrote a book titled “Neural control of the pituitary gland.”, dedicated to the understanding of the neurobiology and underlying pulsatile release of gonadotropic, releasing hormone (GnRH) from the hypothalamus.  For the purposes of testosterone replacement therapy, the hypothalamus is capable of detecting levels of testosterone within the bloodstream, and will as needed, releases through pulsation, gonadotropic releasing hormone, which, as part of a feedback loop allows the anterior pituitary to release both luteinizing hormone and follicle stimulating hormone, which travels to the gonads and contribute to both spermatogenesis and steroidogenesis, the formation of both sperm and testosterone respectively.  With the introduction of exogenous testosterone, the pulsatile secretion of both LH and FSH may be disrupted. This will cause the testes to atrophy due to their being a lack of requirement for them to produce sperm and testosterone.  

How can i prevent my testes from shrinking if I'm on TRT?

So not only will the testes atrophy, but men on TRT may experience a reduced sperm count/fertility due to this negative feedback, action at the level of the pituitary.  This can be combated through the administration of human chorionic gonadotropin, otherwise known as hCG, which is a medication that is a leutenizing hormone analog. It mimics the role of LH in the body and allows for the natural production of testosterone and even sperm in the testes to continue. Other medication, such as a enclomiphene has often been used by fertility specialist for the same purposes, to increase sperm count.

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If you are interested in exploring TRT as a treatment option and would like to speak with an experienced, licensed professional physician to discuss options regarding Low T and the signs/symptoms associated with it, please reach out to our office or learn more by clicking this link to read about HCG or TRT.

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