Does TRT really shrink your balls?

Testicular atrophy and TRT

First things first: yes, undergoing TRT could cause your balls to shrink.

Multiple studies mention testicular atrophy as a possible side effect of TRT. One study found that of the TRT patients who reported testicular atrophy, their testes decreased in volume by an average of 17%. The same study found that it was more likely to affect men with larger testes, and also those who inject testosterone rather take it in gel or tablet form.

Why TRT can lead to testicular atrophy

Your body is a finely-tuned machine, and one slight imbalance can easily lead to another. This is what can happen if you have a testosterone deficiency.

When your body isn’t producing enough testosterone for your needs, it could cause a range of symptoms that seriously affect your quality of life: fatigue, low mood, diminished sexual desire, and many more.

To address that imbalance, many men turn to TRT. But here’s the problem that can arise: when you start adding testosterone from an external source, your body may think there are elevated levels of testosterone in your system.

In some cases, your hypothalamus will then signal to your testes to produce less sperm. Over time - normally around six months - this lack of activity in your testes can mean they start to shrink in size.

But don’t despair. Although that may sound a little worrying at first, the good news is that testicular atrophy shouldn’t actually be a medical concern for most TRT patients.

Is testicular atrophy something to be concerned about?

For most TRT patients, the main issue around testicular atrophy is likely to be personal. Some men may simply not be comfortable with having smaller testes, while others may even see it as emasculating.

But in scientific terms, the main physiological effect of testicular atrophy is decreased sperm production. For some men that will be important: particularly those who plan to have children in the future. A lower sperm count doesn’t make it impossible to have children, but it will make it more difficult.

However, it may be less of an issue for older men. Because smaller testes doesn’t mean lower libido. It’s just a visual difference.

It’s worth mentioning that sperm production returns to normal around 12 months after stopping TRT. There are also testosterone treatments available that don’t affect fertility - more about that in the next section.

As with any medical treatment, it’s important to weigh up the benefits and risks with your TD doctor to decide whether it’s right for you. For some men, TRT (and its side effects) will be a risk worth taking if it counters the symptoms of testosterone deficiency.

Is testicular atrophy treatable?

Testicular atrophy won’t affect everyone who undergoes TRT.

But if you’re concerned about testicular atrophy prior to starting TRT, or have already noticed changes in the size of your testes, there are options to help combat the risk of testicular atrophy associated with TRT.

Some medicines are known to mimic the action of lutenizing hormone (LH), which is believed to help support your body’s sperm production. In cases where there is a clinical need, these medications can be used in combination with TRT to stave off testicular atrophy and a lower sperm count.

testosterone

3 minute read

What is the AMS scale and how does it help diagnose low testosterone?

What is the AMS scale and how does it help diagnose low testosterone? It’s a bit of a paradox: low testosterone is easy to identify, yet millions of men in the UK are going undiagnosed every year. One of the reasons why is that many men simply don’t know the symptoms of testosterone deficiency (TD). The AMS scale is helping to bridge that knowledge gap. It’s a simple way of finding out whether you have symptoms consistent with TD, allowing you to follow up on your results and take better control of your health. Here’s all you need to know about the questionnaire and how it can help to diagnose TD. What is the AMS scale? The Aging Males' Symptoms (AMS) scale is a set of 17 questions that help to identify a testosterone deficiency. You’re presented with a range of symptoms (e.g. sleep problems) and asked to rate their seriousness from 0 (none) to 5 (severe). You’ll get a total score out of 85. A score of 26 or under means you have no significant symptoms consistent with a low testosterone level. 27-36: you have mild symptoms consistent with a low testosterone level. 37-49: you have moderate symptoms consistent with a low testosterone level. Over 50: you have severe symptoms consistent with a low testosterone level. Of course, a high score alone doesn’t necessarily mean you have TD. But if your test does throw up some unexpected results, your next step should be a blood test to confirm the results of the questionnaire. Who is it aimed at? Despite the name, the AMS scale is relevant for men of all ages. Your testosterone levels start to decrease by around 1% a year once you hit your 30s. However, that doesn’t mean TD is limited to over 30s. It can affect younger men too, so the questionnaire is still worth taking if you have a few unexplained symptoms that you can’t get to the bottom of. Which questions does it ask? The AMS scale lists 17 symptoms related to low testosterone levels. You just have to rate the impact of each one. Here is the full list of symptoms in the questionnaire: Decline in your feeling of general wellbeing Joint pain and muscular ache Excessive sweating Sleep problems Increased need for sleep, often feeling tired Irritability Nervousness Anxiety Physical exhaustion / lacking vitality Decrease in muscular strength Depressive mood Feeling that you have passed your peak Feeling burnt out, having hit rock-bottom Decrease in beard growth Decrease in ability/frequency to perform sexually Decrease in the number of morning erections Decrease in sexual desire/libido What are the benefits of the questionnaire? The main aim of the test is to help diagnose a testosterone deficiency. However, there are plenty of other benefits: You can start to join the dots between different symptoms to see if there’s a pattern and underlying cause It quantifies your health issues, allowing you to put a number on things and making it easier to track concerns over time It helps to detect health concerns early on, meaning you can act on unusual results before they become a bigger problem Having a set of results to refer to makes it easier for some men to discuss sensitive issues with their doctor Can the AMS scale diagnose TD? No. Although your AMS results can indicate a testosterone deficiency, only a blood test can tell you for sure whether or not you have one. To confirm a diagnosis of testosterone deficiency, you need to take two tests spaced at least two weeks apart. This is because your testosterone levels fluctuate naturally, so two tests can confirm whether you have consistently low testosterone and can also help to identify a baseline from which to work from. That being said, the questionnaire is generally seen as a good indicator of TD. One study found that it was a reliable way of identifying early symptoms and then monitoring the effectiveness of follow-up treatments. What should I do if my results indicate a potential testosterone deficiency? If you get a score of 27 or more on the AMS scale, it’s recommended that you measure your testosterone levels with a Venous Blood Test (VBT), known as the gold-standard for accuracy and reliability. If the blood test confirms the results of the questionnaire, your next step is to discuss treatment options with a clinician. They may recommend testosterone replacement therapy (TRT), lifestyle changes, symptom management, or weight loss to restore your levels to normal. The numan take The Ageing Males’ Symptoms (AMS) scale is a set of 17 questions that help to identify if you may have testosterone deficiency. Beyond that it can also help you track your health over time, and empower you to make better decisions for your long-term wellbeing. The questionnaire alone can’t diagnose a testosterone deficiency, but it’s a vital first step to identifying and correcting one.