What should I do if my son has one testicle larger than the other?

In boys, asymmetry in testicular size—where one testicle is noticeably larger than the other—may result from conditions such as orchitis or hydrocele, both of which can be managed with medication or surgical intervention.

What should be done if a boy’s testicles are asymmetrical in size?

1. Orchitis: This refers to inflammatory disease of the testis caused by bacterial or viral infection. In addition to unilateral testicular enlargement, clinical manifestations may include erythema and swelling of the affected scrotum, marked tenderness over the involved testicle, and systemic symptoms such as fever, chills, nausea, and vomiting. Antibiotic therapy prescribed by a physician—such as amoxicillin-clavulanate potassium dry suspension or azithromycin dry suspension—may be indicated.

2. Hydrocele: A hydrocele occurs when excess fluid accumulates within the tunica vaginalis cavity of the scrotum, forming a cystic mass that may cause apparent asymmetry in testicular size. Most hydroceles are asymptomatic and are often discovered incidentally during routine physical examination. Typical presentation includes a soft, fluctuant, non-tender cystic swelling in the scrotum or inguinal region. When the hydrocele enlarges significantly, it may cause discomfort or a sensation of heaviness. Surgical intervention—including hydrocelectomy (e.g., tunica vaginalis flap inversion or excision)—is the primary treatment modality. Notably, infantile hydroceles frequently resolve spontaneously without intervention. Asymptomatic, small-volume hydroceles generally require no treatment. However, if the hydrocele is large, tense, and slow to resolve spontaneously, increased intrascrotal pressure may impair testicular development; in such cases, aspiration and drainage may be warranted.

Boys presenting with noticeable testicular asymmetry should seek prompt medical evaluation at a hospital. Delaying consultation risks missing critical diagnostic and therapeutic windows.

We hope the above information is helpful. Wishing you good health and happiness!