Ask the experts

When should I worry about a swollen testicle?

If you notice one of your testicles is swollen, it’s time to see your doctor. A swollen testicle can be caused by a number of health conditions. The good news is most are non-cancerous. Your doctor will examine your testicle to find the cause and decide how, if at all, it needs to be treated.

Swelling happens when fluid starts to build up around the testicle or in other parts of the scrotum (the sac around the testicles). Causes can include:

  • Infection
  • Injury to the testicle
  • Varicocele (enlarged veins in the scrotum)
  • Hydrocele (fluid filled sac around the testicle)
  • Testicular cancer

Teen boys should start examining their testicles once a month. The best time to start the self-exam is during or right after a hot bath or shower.

Do the exam while standing. Gently feel the scrotal sac to find a testicle. Look for swelling in the scrotum. Check each testicle one at a time. Roll the testicle between the thumb and fingers of both hands to feel the whole surface.

You should be gentle, but firm. This will help you find any small (pea-size) hard lumps. Tell your doctor if you feel any lumps, swelling, pain or soreness or if you notice any other changes.

Dr. Anne Calvaresi is the chair of the Urology Care Foundation's Prostate Health Committee. She works in Philadelphia and specializes in urology and prostate health.

How Male Pattern Baldness Drugs Affect Screening Tests for Prostate Cancer

Male pattern baldness is a common problem. By age 35, over 60 percent of American men will have some hair loss. Some men have a receding hairline. Other men have thinning hair at the top of their head.

Many “miracle cures” claim to make men’s hair grow. You may have seen these ads on TV or in magazines. They are not approved by the U.S. Food and Drug Administration (FDA) because they are not effective. But drugs recommended by the American Hair Loss Association are effective. Some drugs for hair loss can affect prostate cancer screening tests. Here’s what you should know.

The prostate is a small gland that is part of a man's reproductive system. The prostate is located under the bladder and helps produce the fluid for ejaculated semen. Prostate-specific antigen, or PSA, is a protein produced by prostate cells. The PSA test is a blood test that measures PSA levels and is done by clinicians to help screen for prostate cancer. Men usually have low levels of PSA in their blood. High PSA levels can be a sign of prostate cancer or other prostate problems, like enlarged prostate or an infection. Regular prostate cancer screenings help detect prostate cancer at an early stage.

Finasteride (brand name Propecia® or Proscar®) is the first-line drug for treating male pattern baldness. Finasteride works well for preventing hair loss, but lowers PSA test results by about 50%. This can affect your doctor’s ability to screen for prostate cancer. Other drugs for male pattern baldness, such as minoxidil (Rogaine), do not affect PSA.

Talk to your doctor about when to start prostate cancer screening with a PSA test. This will depend on risk factors like age, race and family history of prostate cancer. Tell your doctor if you are taking finasteride or any other hair loss prevention products.

Dr. Wayne J.G. Hellstrom is professor of urology and chief of andrology at Tulane University School of Medicine in New Orleans. Louisiana.

When Should Men Get a Testicular Implant?

Testicles, or testes, make male hormones and sperm. Most men are born with two testicles. They are shaped like eggs and are located inside the sac of skin (scrotum) behind the penis.

Sometimes a testicle needs to be removed because of testicular cancer or injury. Testicular cancer is most common in men between the ages of 15 and 44. Injuries to the testicles can happen from playing sports, like baseball. That’s why it’s good to wear a jock strap or hard cup when playing contact sports.

If you need to have a testicle removed, you may consider a testicular implant. A testicular implant is when a testicle-shaped form is placed inside the scrotum. An implant can be placed during the same surgery when they are removing the testicle or at a later time.

Deciding whether or not to get a testicular implant is a personal choice. Some men get testicular implants to help their private parts look “normal.” Some men don’t want an implant and are fine living with one testicle.

Talk with your doctor about the pros and cons of testicular implants. These implants come in different sizes, shapes and textures. Make sure to find out how much a testicular implant will cost and if your insurance will cover it. These factors may affect your decision.

Dr. Jairam R. Eswara is a urologic surgeon at St. Elizabeth’s Medical Center in Boston, Massachusetts with specific training and expertise in urologic trauma and reconstruction.  |  SUMMER 2021  |  UROLOGYHEALTH extra