Some men on testosterone replacement therapy (TRT) notice their testicles become smaller (atrophy) or less firm. This is a known and expected response to TRT for some patients.
In most cases, this is purely cosmetic and does not affect sexual performance, libido, or testosterone levels.
Discomfort is less common, but when present, it may be linked to hormonal suppression, muscle tension in the pelvic region, or both.
At Hormn, we reduce the chance of this occurring by:
Starting with low doses and increasing only as needed
Using small, stable, frequent injections
Monitoring bloodwork to keep hormone levels balanced
Why It Happens
TRT suppresses your body’s natural testosterone production. This reduces stimulation to the testicles from two hormones:
LH (Luteinising Hormone)
FSH (Follicle Stimulating Hormone)
Without these signals, the testicles can:
Reduce in volume (shrink)
Soften in texture
Feel lighter or less dense
This is a cosmetic change only and does not affect your energy, muscle mass, erections, or testosterone levels when on TRT.
Discomfort: What You Might Notice
Some men report a dull ache, tightness, or mild soreness in the testicles or surrounding area. This is not dangerous, and typically passes with time or adjustments to treatment.
In many cases, this is caused not by the testicles themselves, but by:
Tight pelvic floor muscles
Tension in the groin, glutes, or lower back
Poor posture or prolonged sitting
What You Can Do
If you're feeling discomfort:
Try daily pelvic floor stretches (hip flexors, hamstrings, glutes)
Use a foam roller or lacrosse ball to release tension in the adductors and glutes
Avoid sitting for long periods—get up and walk regularly
Limit heavy core training or bracing movements for a few days if tenderness is present
These steps help relieve tension that can contribute to a sensation of heaviness or pressure in the area.
Fertility Considerations
We only prescribe fertility-supporting medications for patients actively planning to conceive in the next 6–12 months. These medications stimulate natural hormone signals to the testicles but are not prescribed for testicular size or comfort.
If you’re thinking about starting a family soon, let your doctor know so the right treatment plan can be discussed.
When to Contact Your Doctor
Reach out if you notice:
Sharp, persistent pain (especially if one-sided)
Swelling, redness, or warmth
Pain lasting more than 7 days
Any new or worsening symptoms
Your doctor can review your bloodwork, assess for other causes (e.g. varicocele), and decide if changes are needed.
Mild testicular atrophy is normal on TRT and usually not a concern. Discomfort is uncommon and often linked to pelvic tension, not the testicles themselves.
Most cases improve with movement, stretching, and time. If you plan to conceive soon, let your doctor know so your care plan can be adjusted.