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Prof. Dr. Ali Avanoğlu
Undescended Testicle • Follow-up

Does the Testicle Grow Normally After Undescended Testicle Surgery?

This is the question families ask most often after surgery: will the lowered testicle grow? In most cases, yes — a testicle brought down into the scrotum grows through childhood and puberty, though it may remain somewhat smaller than the other side. This page explains when that difference is expected and when it's a finding that needs further evaluation.

Who this is forFamilies and teens wondering about testicle size after surgery
Reading≈6 min
ByProf. Dr. Ali AvanoğluUpdated
This page is part of undescended testicle.Read the full treatment overview on the hub page
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in the scrotum
01 · Short answer: it usually grows, but may not be equal02 · What determines growth?03 · How is size measured?04 · Is remaining small the same as atrophy?05 · Evaluation during puberty: when is the difference significant?
In brief5 madde
  • Short answer: it usually grows, but may not be equal: Once a testicle is brought down into the scrotum and reaches its cooler environment, it grows slowly throughout childhood and rapidly during puberty — following the…
  • What determines growth?: Several factors together determine how much the lowered testicle will grow; none of them is decisive on its own.
  • How is size measured?: At checkups, size is first assessed by physical exam and, when needed, with ultrasound; ultrasound isn't needed at every visit.
  • Is remaining small the same as atrophy?: These two situations must be distinguished: remaining small means the testicle lags behind the other side but continues to grow; atrophy means the testicle noticeably…
  • Evaluation during puberty: when is the difference significant?: Puberty is the period when the testicle's growth capacity is ultimately revealed; decisions are made by evaluating volume, hormones, and development together during…
01

Short answer: it usually grows, but may not be equal

Once a testicle is brought down into the scrotum and reaches its cooler environment, it grows slowly throughout childhood and rapidly during puberty — following the same path as a healthy testicle.

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  • That said, the literature frequently reports that, on average, the operated testicle remains somewhat smaller than the other side in adulthood. This difference has two possible sources: the testicle may have lost some tissue during the time it spent undescended, and some testicles are, congenitally, smaller than the other side from the start. Surgery doesn't cause this difference — but the earlier it's performed, the better it preserves the tissue's remaining growth capacity.
  • The most important thing for families to know is this: being somewhat smaller than the other testicle doesn't mean that testicle isn't functioning. Hormone production and sperm production aren't exactly proportional to volume; evaluation looks not only at size but also at consistency, the growth curve, and hormone levels during puberty.
02

What determines growth?

Several factors together determine how much the lowered testicle will grow; none of them is decisive on its own.

  • Age at surgery (earlier surgery: better growth)
  • The testicle's starting position (inguinal canal versus high intra-abdominal)
  • Extent of surgery (single-stage or staged, whether the vessel is divided)
  • The testicle's congenital size and tissue quality
  • Whether it is unilateral or bilateral
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  • Age at surgery is the best-known factor. The number of sperm precursor cells (germ cells) declines over the years the longer the testicle remains in a warmer environment; randomized studies have shown that orchiopexy performed within the first year of life preserves these cells better and results in better subsequent testicular growth. This is why guidelines recommend the 6-to-12-month window.
  • The testicle's starting position also matters: a testicle located in the inguinal canal, close to the scrotum, usually grows well; a testicle located high in the abdomen may both start with weaker tissue and carry a risk of restricted blood supply in staged procedures (such as Fowler–Stephens, where the vessel is divided). Other factors include how much the blood vessels were stressed during surgery, the testicle's congenital size, and whether one or both sides are affected.
03

How is size measured?

At checkups, size is first assessed by physical exam and, when needed, with ultrasound; ultrasound isn't needed at every visit.

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  • In a young child, the physician assesses the testicle by hand, comparing it with the other side, and keeps a record. Once puberty begins, volume in milliliters is estimated using an orchidometer — a measuring tool resembling a string of beads of different sizes. Ultrasound calculates volume more precisely by measuring the testicle's three dimensions; it's preferred during puberty, when a significant difference is suspected, or when consistency changes.
  • What matters more than any single measurement is the trend: are both testicles growing together, and is the difference between them staying stable or widening? In our practice, these measurements are kept in the same file from childhood through adulthood, so that comparisons made during puberty can be made against data from years earlier.
04

Is remaining small the same as atrophy?

These two situations must be distinguished: remaining small means the testicle lags behind the other side but continues to grow; atrophy means the testicle noticeably shrinks after surgery and hardens as it loses function.

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  • Atrophy usually becomes apparent within the first year and is related to stress on the blood vessels during surgery, or to insufficient blood supply in staged procedures; the higher the testicle started, the greater the risk. Remaining small, on the other hand, is a stable difference over the years, and the testicle keeps its soft, regular consistency.
  • The physician is the one who makes this distinction; what's expected of the family is to keep up with checkups and not wait for the next appointment if they notice a sudden decrease in size or hardening in consistency. What to do about an atrophic testicle — whether to monitor it or remove it — is discussed individually with the teen or adult.
05

Evaluation during puberty: when is the difference significant?

Puberty is the period when the testicle's growth capacity is ultimately revealed; decisions are made by evaluating volume, hormones, and development together during this time.

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  • A mild difference compared with the other testicle usually doesn't require further testing, especially if the operated testicle continues to follow a normal growth trend. If the difference is significant, if pubertal development is delayed, or if there's a history of bilateral involvement, hormonal function is evaluated with FSH, LH, testosterone, and inhibin B; pediatric endocrinology is involved when needed. In adulthood, semen analysis is the most direct test of reproductive capacity.
  • In a unilateral history, if the other testicle is healthy, the paternity rate is close to that of the general population; a testicle that remains small generally doesn't change this picture. In a bilateral history, the growth of both testicles is monitored more closely. Follow-up continues with the same team, together with adult urology.
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Frequently asked questions
When does the testicle start growing after surgery?
In childhood, the testicle grows slowly on both sides; it isn't realistic to expect a visibly noticeable change in the first year after surgery. The real growth begins with puberty. What matters in the first year is that the testicle stays in the scrotum and doesn't noticeably shrink.
How much difference between the two testicles is normal?
Even in healthy men, the two testicles aren't perfectly equal; it's common for the operated testicle to remain somewhat smaller. Rather than giving a fixed cutoff, the physician looks together at whether the difference has stayed stable over the years, the testicle's consistency, and pubertal development.
Does a testicle that stays small prevent having children?
In a unilateral history, if the other testicle is healthy, the paternity rate is close to that of the general population, and a testicle that remains small generally doesn't change this. In a bilateral history, reproductive potential is monitored more closely. A definitive answer comes from semen analysis in adulthood.
Can hormones be given to help it grow?
In a unilateral case, hormone therapy is not routinely recommended for the purpose of enlarging the testicle. In a bilateral history, endocrine treatment may be considered in selected cases to support reproductive potential; this decision is made jointly with pediatric urology and endocrinology.
The ultrasound report says 'small' — should we be worried?
A single ultrasound measurement alone doesn't determine the decision. What matters is the difference from the other testicle, its consistency, and the trend compared with previous measurements. Bring the report to your checkup appointment; your physician will evaluate it together with the exam.
←Previous • Follow-upLong-Term Follow-UpNext • Follow-upCheckups During Puberty and Adulthood→
Related pagesFull index →
After surgeryTesticular Atrophy After OrchiopexyTesticular atrophy is the shrinking of the testicle after surgery and the partial or complete loss of its function. It is one of the most discussed long-term outcomes of orchiopexy (fixing the testicle in the scrotum), and the risk varies significantly depending on the testicle's preoperative position. This page explains the causes, the higher-risk groups, and how it is monitored.Follow-upLong-Term Follow-UpUndescended testicle treatment doesn't end with surgery. Whether the testicle stays in place in the scrotum, grows normally, and develops as expected through puberty is monitored over years; follow-up continues seamlessly from pediatric urology into adult urology, and this page walks through that timeline step by step.Follow-upCheckups During Puberty and AdulthoodAn undescended testicle that was operated on in childhood still deserves monitoring during puberty and adulthood. By this stage, the question is no longer 'is the testicle in the scrotum,' but 'is it developing as expected, what is reproductive capacity like, and is there awareness around cancer risk.' This page is written for teens, young adults, their families, and adults who had surgery in childhood.Adolescents and adultsUndescended Testicle and FertilityThe most common question asked by men with a history of an undescended testicle is whether they will be able to have children. The answer differs greatly between unilateral and bilateral cases: in unilateral cases the paternity rate is close to that of the general population, while in bilateral cases it drops markedly. This page explains the reasons, the effect of timing, and the path of evaluation in adulthood.
Undescended Testicle topic clustersMain treatment page →
Basics 7Diagnosis and evaluation 6Surgery in children 10Special situations 4After surgery 6Adolescents and adults 6Follow-up 3
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