Key Points

• Yes, some men may appear to have larger testicles than others. Perhaps they could be called giant testicles.
• However, it’s nearly always an appearance thing—they only look like huge balls. There’s little to no difference in actual size.
• It shouldn’t be anything to brag about, either. Some medical conditions could be at play and necessitate a visit to a doctor.

　Sometimes, it seems like guys can’t help but compete with one another, and sometimes—for better or worse—penis size can be part of that. While men famously get hung up about who’s more hung, some may notice differences in testicle size, too.

　What’s the deal with that testicle size variation? Why do some men have giant balls? What might cause a guy to have smaller balls? Perhaps most importantly, is it anything to be concerned about?

　What are testicles?

　Testicles are the famously sensitive small organs dangling below the penis and inside the scrotum. They are key components in the male reproductive apparatus. They’re responsible for producing testosterone, and they serve as the home for sperm to develop and mature before they’re sent out to do their thing.

　Data shows that testicles are usually about 4 centimeters by 3 centimeters by 2 centimeters, or about 2 inches in length. Urologists who specialize in male sexual health—and remember, they’ve likely examined more testicles than you—will tell you there’s not much variation in testicle size.

　”When you talk about average testicle size, if there’s nothing else going on, it’s a pretty narrow standard deviation,” said Scott D. Miller, M.D., the medical director of Wellstar Urology in Atlanta. “A lot of it’s going to be related to, is it a 6-foot-5 person versus a 5-foot-5 person. Unless there’s an abnormal condition, men do not have significantly larger testicles.”

　They only appear to be huge balls

　When you start to get into some conditions that may affect testicle size, you quickly learn that we’re usually talking about the appearance of a difference in testicle size.

　For instance, guys might say their balls “shrink” when they come out of cold water, but in reality, the actual testicles remain the same size. The cold triggers what’s called the cremasteric reflex, which refers to the involuntary muscle that raises and lowers the testicles to protect them and regulate their temperature.

　Your scrotum may appear smaller, but your testicles are the same size.

　Many other conditions that may make one or both testicles appear larger are actually caused by issues with nearby structures within the scrotum, not the testicle.

　”The most common reasons for a change in size are hydroceles, or sometimes hernias,” Miller said. “That’s not really the testicle itself, but it may feel like it.”

　A hydrocele is a condition in which the membrane surrounding a testicle becomes filled with fluid, which might make it appear larger. It’s mostly benign and easily treatable.

　When a man develops an inguinal hernia—a loop of the intestine pushes down through the opening where his testicle dropped when his body was developing as a fetus—his scrotal sac can appear to be larger or fuller.

　In both cases, the actual testicle remains unchanged.

　”There are some other conditions that men might confuse for an enlarged testicle,” Miller said. “The structure behind the testicle, called the epididymis, can form a cyst called a spermatocele. Then there are things like varicocele, which is the equivalent of varicose veins in the veins that go down to the testicle itself.”

Can shrinkage be more than just getting out of the pool?

　While significantly larger testicles aren’t common, smaller-than-average testicles can be.

　”By far the most common reason [for smaller testicles] is when you have a condition where you produce less testosterone,” Miller said. “There are a lot of conditions that can be related to that. Sometimes, those are just hormonal related, to do with the relationship between the pituitary and the testicles.

　”Another common one is any type of anabolic steroid use, particularly testosterone. The more you take it, and the longer period, the more shrinkage you have.”

　When your body is functioning as it should, your pituitary gland sends signals to the testicles to produce testosterone, calibrating it carefully based on how much testosterone is already in your bloodstream.

　So when men start taking exogenous testosterone—testosterone sourced from outside the body—the pituitary detects sufficient levels and stops sending those signals. Basically, the pituitary gland cuts the testicles out of the loop, so the testicles begin to atrophy from disuse.

　There are ways to manage this effect and limit the extent of the shrinkage, even for men on testosterone replacement therapy (TRT).

　”Testosterone replacement therapy may lead to smaller testicles,” said Amy Pearlman, M.D., a men’s health specialist and co-founder of Prime Institute in Fort Lauderdale, Florida. “However, when I start men on testosterone therapy, we discuss that this therapy can lead to testicular shrinkage.

　”Fortunately, there is another medication I can use to help prevent shrinkage in men who find this bothersome. Reducing the testosterone dose may also reduce the risk of testicular shrinkage.”

　One option is combining TRT with human chorionic gonadotropic hormone (hCG), which instructs the testicles to continue producing testosterone and may help prevent infertility and testicular shrinkage.

　The bottom line

　A slight variation in testicle size is normal, but if you notice any testicular changes over time, you should make an appointment with a healthcare provider. That goes double if the change is a lump or a bump on a testicle, as that may be a sign of testicular cancer.

​　Most of the conditions outlined above are easily treatable, but any delay can complicate matters.