Why Do My Balls Hang So Low?
If you've ever been insecure about the appearance of your balls, you're not alone. Penis insecurity is obviously more common, but our cultural fascination with testicles dates back at least to the sculptors of ancient Greece who analyzed scrotums in order to depict them accurately. Even these artistic masterminds occasionally got it wrong; they tended to make the left testicle larger and lower-hanging, whereas, in reality, the right one is generally bigger.
Mistakes like these can be forgiven, as testicles are pretty temperamental. They can even vary in appearance from one hour to the next. Physiologically, these egg-shaped glands play a purely practical role in making semen and testosterone, and they're encased in a sack of skin called the scrotum. Sometimes, balls hang low and loose in the scrotum; other times, they sit high and tight.
A variety of factors can cause these slight changes, a majority of which are nothing to worry about.
Think of your scrotum as a thermostat
Without cosmetic or surgical intervention, there's no real way to control the appearance of your testicles.
"I suppose you could squeeze them up if you want, but you don't really have voluntary control over where they are," explained Michael Werner, M.D., the founder and medical director of New York-based Maze Men's Sexual & Reproductive Health, who has seen thousands of testicles throughout his career, and no pair has ever looked identical. "Like faces, genitals are pretty unique."
Some balls naturally hang lower than others, but the main factor that determines their appearance on a day-to-day basis is temperature.
"Like a thermostat in your house, the scrotum rises and falls to keep the testicles at precisely 95 degrees [Fahrenheit], three or so degrees below body temperature," said Paul Turek, M.D., a urologist and the founder of the Turek Clinic in Los Angeles. "The way this works is through a net-like, webbed muscle that exists within the skin of the scrotum, called the cremaster muscle."
This muscle expands and contracts depending on body temperature. If you're hot, your testicles hang low and loose, essentially creating distance between your testes and your body. If you're cold, the scrotum tightens up to bring the testes high.
Testicles tend to sag with age
As we age, our bodies naturally start producing less collagen. According to a 2013 article published in Skin Research and Technology, this means our skin becomes less elastic and more prone to wrinkles as we grow older.
"The cremaster muscle also gets weaker over time, similar to other muscles in the body," Turek explained.
Testosterone levels and testicular volume deplete throughout later life, too. In a 2011 study published in Molecular Imaging Biology, researchers found testicular volume significantly declines after the age of 60. The testicles shrink, so the scrotum appears saggier with less volume to fill it. Small testes can be an indicator of low fertility.
"If you do notice you have small testes, I would go for a semen analysis to check your levels haven't deteriorated down to zero," Werner said.
Saggy balls alone are rarely cause for concern
Varicoceles, or dilated veins in the scrotum, can cause the testicles to sag lower than normal. They're common, especially during puberty. According to Turek, this "bag of worms" tends to be accompanied by other symptoms, such as a dull, aching pain.
"Blood in these veins flows downward toward the testicle instead of upwards against gravity, making the blood pool around the testicle," Turek said, adding that this pooling creates heat, meaning the balls sag lower to moderate their temperature.
Varicoceles can manifest in later life, too. A 2018 article published in Nature Review Urology describes them as the "most common correctable cause of male infertility," and they're usually treated by a procedure known as a varicocelectomy.
"If you get a varicocele out of the blue when you're older, it's possible you have a tumor that's pressing up against the vein," Werner said, reinforcing that saggy testicles won't be the only symptom. "You would see the vein poke through the skin…[and experience] a dull, achy feeling that improves when you lay down and gets worse when you lift, strain and stand."
Acute testicular pain is an emergency, Werner cautioned, adding that testicular torsion is a common cause. Torsion happens when the testis twists on itself and cuts off the blood supply. Once the blood supply is cut off, you have only around six hours to save the testis, he said.
Don't obsess over your genitals
Despite the growing market for genital beauty procedures such as Scrotox and scrotal rejuvenation, Werner tells people not to obsess about the way their naughty bits look.
Werner said he has nothing against Scrotox and similar procedures, which paralyze the cremaster muscle so it doesn't pull the testes, but the procedures are relatively new. This means researchers don't know whether Scrotox affects sperm count, he explained, though he theorized any potential effects would likely be temporary, as the effects of Scrotox wear off in a few months.
As for Turek, he simply concluded that scrotums can be "moody." So if your testicles are hanging lower than usual, they'll snap out of it soon enough.
"There's no need for concern," he reiterated. "They're just doing their job and staying cool."