Shrinking Crown Jewels

Dear Dr. G,

Thank you for answering my query. I would really appreciate your frank opinion about my shrinking testicles.

I am in my mid-40s, a father of two, and have been facing a shrinking “crown jewel” in the sac for the last three years.

I first noticed something was not quite right when I self-examined in the shower. I first observed a bit of dilated blood vessels on the left testicles a while ago. When I felt my testicles, it felt softer and smaller.

Despite the obvious shrinkage, I experience no pain or discomfort. My wife told me my libido is on the decline. Personally, I just think it is to do work schedule and age, rather than the shrinking sacs.

I continue to get morning erection and the hardness is sustainable during sex. Truthfully, my ejaculation and climax remains unchanged over the years.

Apart from my curiosity and dented pride, I really get by without major issues both inside and outside the bedroom. I would like to put Dr. G on the spot to enquire why my balls are shrinking.

Is this life-threatening? Will this eventually affect my sex life? What will be the treatment to restore my balls?

Regards
Diminishing Ball

Most men are born with two testicles hanging loosely in the scrotum, attached to the spermatic cords. A male testicle is about 1 cubic centimeter at birth and remains small throughout childhood. The onset of testicular growth begins before puberty and reaches adult size towards the end of teenage years.

Although the testicles tend to grow at the same rate, one ball tends to outgrow the others. Hence, it is common for men to notice differences in gonadal sizes, and the right is generally bigger than the left. It is also common to observe one ball to hang a little lower than the other. Although the testicular sizes are quite variable, the differences are not significant amongst adult men. The average shape and size of the balls is an oval-shaped manhood around 4x3x2cm.

The medical condition characterised by the diminishing size of the testicles is called testicular atrophy. The shrinkage is a gradual and permanent phenomenon, in comparison with transient changes that may be observed during cold weather. The decline in testicular size is common amongst men with advancing age and accompanied by the loss of testicular functions. The loss of germ cells and Leydig cells, that produces sperms and testosterone respectively, is observed in testicular atrophy.

Hence men with testicular shrinkage will usually encounter decline in fertility and sex drive in general. It is natural for men to experience gradual diminishing testicular sizes over many years, therefore the differences in size or symptoms are hardly noticeable.

Marked decline in testicular sizes is also observed in other medical conditions. These include anabolic steroid abuse, testosterone replacement and exposure to estrogen. Infections of the testicles such as chlamydia, gonorrhea and mumps can cause initial acute painful swelling of the testicles, followed by drastic shrinkage afterwards.

Excessive alcohol consumption is also well known to be associated with shrinking balls. This is believed to due to direct tissue damage of the testicular cells and indirect effect of ethanol on hormonal balance. The other common cause of testicular shrinkage is the engorgement of the veins of the scrotum, induced by varicocele. The dilation of the veins is more pronounce in the left sac, associated with more drastic shrinkage of the left testis.

Varicocele is one of the commonest causes of infertility in men. The treatments of infections, lifestyle changes or corrective surgery of varicocele are known to improve the functions of the gonads, but may not necessarily restore the size of the crown jewels in the sac. Some herbal remedies and hormonal interventions have anecdotal reports of restoring the testicular sizes to its former glory. However, the improvement may not be sustainable and the efficacy often questionable.

On the flip side, a 2013 study highlighted men with smaller testicles were associated with more nurturing quality amongst fathers. The reduced testosterone level due to the reduction in testicular volume is believed to induce higher level of paternal caregiving.

Leonardo da Vinci famously said: “I love those who can smile in trouble, who can gather strength from distress, and grow brave by reflection. It’s the business of little minds to shrink, but they whose heart is firm and whose conscience approves their conduct will pursue their principles to the death.”

Testicular atrophy is non-life threatening and an inevitable phenomenon in most men with advancing age. Dr. G is often put on the spot by men curious about the diminishing fullness of his crown jewels in the sacs.

As the testicles have served their purpose of fertility in the younger days and testosterone is still maintaining some degree of sexual ability, it is better to smile and gather strength despite the looming prospect of decline in sexual performance in the future due to testosterone depletion.

“It’s the business of balls to shrink, but only they whose hard is firm, and whose paternal caregiving approves their conduct will pursue their principles unto death!”

Dr George Lee

Dr George Lee is a consultant Urologist and Clinical Associate Professor whose professional interest is in men’s health. The column “Putting Dr G on the spot” is a forum to help men debunk the myths and taboos on men’s issues that may be too “hard” to mention. You can send him questions at askdrg@thestar.com.my