Do balls drop with old age? Understanding normal age-related changes

Oct 8, 2025 3 min read •

senior care Men's Health Healthy Aging

As men age, their body undergoes many changes, and the scrotum is no exception. In a natural part of the aging process, the scrotal skin loses elasticity, causing it to stretch and hang lower. We’ll explore the science behind this phenomenon and address the common question: "Do balls drop with old age?".

Quick Summary

As men get older, the scrotum naturally sags due to a loss of skin elasticity and collagen, making it appear that the testicles have dropped lower. This is a typical age-related change that typically isn't a cause for concern unless accompanied by other symptoms like pain or swelling. Normal age-related factors like reduced collagen, weaker cremaster muscles, and the effect of gravity all contribute to the more pronounced lower hanging appearance over time.

Key Points

Scrotal Sagging is Normal: As men age, the skin of the scrotum loses elasticity, causing it to stretch and hang lower, a natural and common change.
Testicles Remain in Place: The testicles themselves do not drop; it is the loosening of the scrotal sac that creates the appearance of them hanging lower.
Contributing Factors: Loss of collagen, weakening of the cremaster muscles, and gravity all contribute to the scrotal sagging seen with aging.
When to See a Doctor: While sagging is normal, you should consult a doctor for symptoms like pain, lumps, swelling, or significant changes in size, as these could indicate a medical issue like a varicocele or testicular atrophy.
Not Just Cosmetic: Age-related changes can also include a gradual decline in testosterone and altered sperm quality, which can affect fertility and overall health.
Lifestyle Management: Maintaining a healthy lifestyle, including good diet, exercise, and avoiding smoking, can promote overall reproductive health, but will not reverse natural sagging.
Surgical Options Available: For men who are concerned about the appearance of excessive sagging, a surgical procedure called scrotoplasty can remove excess skin.

Normal aging changes in the scrotum and testicles

The perception that "balls drop with old age" is a common concern based on observable changes in the male anatomy. The testicles themselves do not technically "drop" from their position inside the scrotum. The scrotum, which holds the testicles, loses elasticity with age, leading to a lower-hanging appearance. This is a normal part of aging.

The science behind scrotal sagging

Several factors contribute to scrotal sagging in older men:

Loss of collagen and elasticity: Like other skin, scrotal skin loses collagen and elastin over time, becoming thinner and stretchier. This is a primary cause of sagging.
Weakened cremaster muscles: These muscles raise and lower the testicles for temperature regulation. With age, they weaken, leading to a lower position.
Impact of gravity: Gravity's effect, combined with decreased skin elasticity and muscle tone, contributes to the lower-hanging appearance.

Potential medical causes and when to see a doctor

While sagging is normal with age, other conditions can affect the scrotum. Consult a doctor if you notice any of these symptoms along with changes in scrotal appearance:

Varicocele: Enlarged veins in the scrotum can feel like a "bag of worms" and may cause the testicles to hang lower.
Inguinal hernia: Tissue pushing through abdominal muscles can cause a bulge, pain, and swelling in the groin or scrotum.
Testicular cancer: A lump, swelling, or enlargement of the testicle requires medical evaluation.
Testicular atrophy: The actual shrinking of testicles can be caused by various factors and needs medical attention.

The relationship between aging, hormones, and testicular function

Testicular aging impacts reproductive and overall health, affecting hormone production and sperm quality.

Declining testosterone levels

As men age, testosterone levels gradually decline. This can cause symptoms like decreased libido, erectile dysfunction, loss of muscle mass, fatigue, and mood changes.

Effects on fertility and sperm quality

Sperm quality and DNA integrity decline with age, particularly after 40. This can increase the risk of miscarriage and genetic mutations.

Comparative table of normal vs. abnormal scrotal changes


Feature	Normal Age-Related Change	Potentially Abnormal Change (Requires Evaluation)
Scrotal Skin	Thinner, looser, and more wrinkled with visible sagging.	Swollen, discolored, or asymmetrical appearance.
Testicle Position	Hanging lower due to weakened muscles and loss of skin elasticity.	One testicle consistently hangs much lower, especially with a mass or pain.
Testicle Size	Gradual, moderate decrease in volume after age 60.	Sudden or significant shrinkage (testicular atrophy).
Pain or Discomfort	Generally painless, though excessive sagging can cause mild discomfort.	Chronic pain, swelling, or a feeling of heaviness or aching.
Other Symptoms	May be accompanied by signs of lower testosterone.	Associated symptoms like a mass, lump, or sudden severe pain.

Lifestyle factors and management options

While aging is natural, healthy habits can support overall health and may help mitigate some symptoms. Lifestyle choices support skin health and hormonal balance but won't reverse aging's effects.

Maintain skin health: Sun protection, hydration, and a healthy diet can support skin health.
Exercise regularly: Physical activity helps maintain muscle tone, including cremaster and dartos muscles.
Avoid smoking and limit alcohol: These can accelerate aging and negatively impact testicular health.
Consider surgical options: Scrotoplasty can remove excess scrotal skin for those bothered by sagging.

When to seek professional advice

Understanding normal age-related changes is helpful, but be aware of signs of more serious issues. Any lump, swelling, significant pain, or change in testicle size or shape warrants a visit to a healthcare provider. A urologist can diagnose potential issues.

For more information on men's reproductive health, consult the National Library of Medicine: https://www.ncbi.nlm.nih.gov/

Conclusion

Scrotal sagging is a normal part of aging caused by loss of skin elasticity and muscle tone. While this is typical, be aware of other potential issues. Understanding these changes and seeking professional help for concerning symptoms is important for men's health as they age.

Frequently Asked Questions

Yes, it is a very normal part of the aging process for the scrotum to stretch and hang lower. This is primarily due to the skin losing collagen and elasticity over time.

Aging causes the skin to lose collagen, which makes it less elastic. Additionally, the cremaster muscles that raise and lower the testicles can weaken, contributing to a lower-hanging appearance.

Sagging is usually not a concern, but you should see a doctor if you notice any associated pain, swelling, lumps, or if one testicle is significantly different in size or shape than the other.

While the physical sagging does not directly affect fertility, age-related changes that cause the sagging are often correlated with declines in sperm quality and testosterone. However, these are separate processes.

There is no strong scientific evidence that Kegel exercises can prevent or reverse the sagging of scrotal skin. The causes are primarily related to skin elasticity and muscle changes that exercises cannot control.

Yes, a cosmetic surgical procedure called a scrotoplasty or scrotal reduction can remove excess skin to reduce the sagging. However, results are not permanent as aging will continue.

Medical conditions like a varicocele (enlarged veins in the scrotum), inguinal hernia, or a testicular cyst can sometimes mimic or contribute to the appearance of sagging. A doctor can help diagnose these.

References

Medical Disclaimer

This content is for informational purposes only and should not replace professional medical advice. Always consult a qualified healthcare provider regarding personal health decisions.