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April is Testicular Cancer Awareness Month, which means health organizations are asking men to check themselves. It's awkward, uncomfortable, and the risk seems small. But testicular health isn't just about cancer screening. Your testicles are where your body makes most of its testosterone, and when something goes wrong there, the problems go way beyond cancer.
How to Tell If You Have Testicular Cancer
According to the National Cancer Institute, about 9,720 men were expected to be diagnosed with testicular cancer in 2025. It's the most common cancer in men ages 15 to 44, with an average diagnosis age of 33.
Signs of testicular cancer are usually physical and often painless. A testicular cancer lump typically presents as a hard, painless mass on one testicle, often discovered during a shower. Other warning signs include a dull ache in the lower abdomen or groin, a feeling of heaviness in the scrotum, or sudden changes in testicle size.
The challenge is that testicle pain can have many causes. But waiting costs valuable time. The Urology Care Foundation reports that most men wait five months or longer before reporting symptoms. Early-stage testicular cancer has a cure rate above 95%, while later stages require more aggressive treatment.
How to Test for Testicular Cancer
Testing for testicular cancer starts with monthly self-examination during or after a warm shower, when the scrotal skin is relaxed. Here's the process:
- Cup one testicle at a time using both hands, placing your index and middle fingers underneath and your thumbs on top
- Roll the testicle gently between your fingers with slight pressure
- Feel for any hard lumps, changes in size, or irregularities in texture
- Familiarize yourself with the epididymis, the rope-like structure on the back of each testicle
The epididymis feels softer than the testicle itself and is completely normal. It's also normal for one testicle to hang slightly lower or be marginally larger than the other. If you find anything unusual, a lump that feels firm, a sudden size change, or persistent swelling, see your doctor immediately. Your physician will do a physical exam and likely order an ultrasound. Blood tests may also be ordered to check for markers that some types of testicular cancer produce.
Can Testicular Cancer Cause Low Testosterone?
Yes, testicular cancer can cause low testosterone both at diagnosis and after treatment. Your testicles house Leydig cells, which produce about 95% of your body's testosterone. When cancer damages these cells or treatment removes a testicle, testosterone production capacity drops.
Research from Indiana University School of Medicine found that 38% of testicular cancer survivors had clinically low testosterone or required testosterone replacement therapy. Compared to survivors with normal testosterone, those with low levels were significantly more likely to take medication for high cholesterol (20% vs. 6%), high blood pressure (19% vs. 11%), erectile dysfunction (20% vs. 12%), and diabetes (6% vs. 3%). Being overweight or obese increases this risk.
Will a Vasectomy Reduce Testosterone?
No, a vasectomy does not reduce testosterone levels. Research consistently shows that vasectomy has no long-term impact on testosterone production. During the procedure, only the vas deferens tubes carrying sperm are cut. Testosterone is produced by Leydig cells inside the testicles and travels through the bloodstream, not through these tubes.
One five-year prospective study followed 54 men after vasectomy and found no significant alteration in testosterone levels. A 2018 study examining 485 men confirmed no changes in total or free testosterone. If you're experiencing symptoms of low testosterone after a vasectomy, other factors like age or weight gain are the likely culprits.
Testicular Shrinkage on TRT
Testicular shrinkage on TRT affects some men on certain types of testosterone replacement therapy. When you take testosterone from outside your body, your brain thinks you have enough and stops sending signals to your testicles.
Without these signals, the testicles stop making their own testosterone and sperm, which may cause them to shrink.
How to Prevent Testicular Shrinkage on Testosterone
Preventing testicular shrinkage on testosterone involves using a medication called HCG, which acts like the natural hormone that tells your testicles to keep working even when you're on TRT. Studies show that HCG doses of 250 to 500 IUs twice weekly can maintain or restore testicular size. For men who want to increase male fertility while on TRT, HCG is essential, as it can restore both testicular size and sperm production.
An alternative is clomiphene citrate, a pill that helps your body produce its own testosterone signals naturally. Unlike HCG injections, clomiphene citrate is taken as a pill, though results may take several months.
Can Low Testosterone Affect Fertility?
Yes, low testosterone can affect fertility. Research from Yale Fertility Center found that men with total testosterone below 264 ng/dL had significantly worse sperm quality and lower live birth rates. In couples where no clear cause of infertility was found, having low testosterone in the male partner was linked to about a 30% lower chance of achieving a live birth.
Because testosterone helps regulate sperm production, low levels can quietly interfere with conception even when other testing appears normal. The encouraging part is that once identified, low testosterone is often a treatable factor in the fertility journey.
Your Action Plan This April
This April, take testicular health seriously. Your testicles are where your body makes most of its testosterone. When that production drops, you can lose important health benefits, including muscle mass, bone strength, heart health, and how your body uses energy.
Start Monthly Self-Exams
Mark monthly testicular self-exams on your calendar for the same day each month. Consistency catches problems early. If you find anything unusual, a lump, swelling, pain that persists, or a change in size, see your doctor immediately. Don't wait months to report symptoms. Early detection of testicular cancer provides a cure rate above 95%.
Address Hormonal Concerns
If you're on testosterone replacement therapy and concerned about testicular shrinkage or fertility, talk with your healthcare provider about adding HCG. If you've been treated for testicular cancer and are experiencing persistent fatigue, low sex drive, or difficulty maintaining muscle mass, request blood work to check your hormone levels.
Research showed that survivors who exercised regularly had higher testosterone levels than those who didn't. Even when your testicles aren't working at full capacity, staying active can help you get the most out of what they're still producing.
Testicular health is about protecting where your body makes testosterone and understanding how that affects everything from your fertility to your long-term health.
This April, take the screening seriously. Your testicles do more than you think.
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