The scrotum does tend to hang lower as men age, and it is one of the more reliably noticeable changes in male anatomy over time. The primary driver is not anything happening to the testicles themselves but rather a gradual loss of structural support in the scrotal skin, connective tissue, and the muscle responsible for pulling the testes upward. The result is what urologists call scrotal laxity, and while it is almost universal to some degree, it varies widely from person to person depending on genetics, body composition, and lifestyle factors.
What Actually Changes With Age
The scrotum is a uniquely elastic pouch of skin, and it relies on collagen and elastin fibers to maintain its shape and firmness. Like skin everywhere else on the body, scrotal skin loses these structural proteins over the decades. Collagen production slows, existing fibers fragment, and the elastic recoil that kept the scrotum relatively taut in younger years gradually weakens. The scrotal skin also thins with age, compounding the effect. This combination of thinning, wrinkling, and elongation is the main reason older men notice their scrotum sitting noticeably lower than it did in their twenties or thirties.
Scrotal laxity is recognized in dermatology and urology as a distinct morphological change associated with aging. A review of scrotal rejuvenation approaches identified laxity and wrinkling as key age-related scrotal changes, alongside vascular changes like angiokeratomas and alterations in scrotal hair patterns.1PubMed Central. Scrotal Rejuvenation The process is gradual enough that most men do not notice a dramatic shift at any one point. Instead, it accumulates year over year, becoming most apparent after about age 50.
The Cremaster Muscle and Its Role
Underneath the scrotal skin sits the cremaster muscle, a thin layer of striated muscle that wraps around each testicle and spermatic cord. Its job is to raise and lower the testes in response to temperature changes, physical stimulation, and certain reflexes. When you step into cold water and your scrotum tightens up against your body, that is the cremaster contracting. When you are warm and relaxed, it lengthens, letting the testes hang further from the body.
Like other skeletal muscles, the cremaster loses mass and tone with age. Its contractions become less vigorous, which means it does a poorer job of actively pulling the testes upward. Research on cremaster muscle physiology has shown that this muscle behaves somewhat unusually compared to other striated muscles, with increased contractility at higher temperatures rather than lower ones, reflecting its specialized role in temperature regulation of the testes.2PubMed. Contractility and electrophysiological parameters of cremaster muscles of boys with a hernia or undescended testis As this muscle weakens over time, it contributes to the lower resting position of the testes.
The effect compounds with the skin changes. Looser skin plus a weaker muscle means there is less resistance to gravity. The cremaster still functions in older men, and you will still see scrotal retraction in cold environments, but the baseline resting position trends steadily downward.
Testicular Volume Changes Are a Separate Story
A common assumption is that the testicles themselves are getting bigger or heavier, pulling the scrotum down. The reality is the opposite. Testicular volume actually decreases with age, especially after 60. One imaging study found that testicular volume increases rapidly during puberty, peaks around age 30, holds relatively steady in a plateau through the fifties, and then drops significantly after 60.3PubMed. The effects of aging on testicular volume and glucose metabolism: an investigation with ultrasonography and FDG-PET An earlier clinical study reported that among men over 60, about three-quarters showed decreased testis length and over a third showed decreased testicular volume.4The American Journal of Medicine. Declining testicular function with age: Hormonal and clinical correlates
So the testicles are actually getting lighter and smaller, not heavier. The lower hang has nothing to do with increased testicular weight pulling things down. It is almost entirely about the support structures giving way. Think of it like a hammock whose ropes have stretched: the person lying in it has not gained weight, but the hammock sags lower anyway.
How Temperature Regulation Fits In
The entire reason the scrotum exists as an external structure is to keep the testes a few degrees cooler than core body temperature. Sperm production is sensitive to heat, and the scrotal position allows for temperature regulation through a combination of muscle adjustment, blood vessel countercurrent exchange, and evaporative cooling from the thin scrotal skin. When the body needs to cool the testes down, the cremaster relaxes and the scrotum drops, increasing surface area. When warmth is needed, the muscle contracts and pulls the testes close to the body.
In younger men, this system is responsive and dynamic. You can see the scrotum change position noticeably throughout the day depending on ambient temperature, physical activity, and arousal state. In older men, the system still operates, but with less range. The resting position is lower because the cremaster’s baseline tone is reduced, and the skin has less elastic snap to return to a tighter configuration. The thermoregulatory function does not disappear entirely, but it becomes less precise.
Whether this reduced thermoregulatory responsiveness matters for fertility is a somewhat academic question for most older men, since sperm production has already declined for hormonal reasons by that age. But it does mean the scrotum spends more time in an elongated state, which reinforces the visual impression that things have dropped over the years.
Practical Concerns Beyond Appearance
For many men, a lower-hanging scrotum is simply a cosmetic observation with no functional consequences. But past a certain point, significant scrotal laxity creates real annoyances. The scrotum can get caught or pinched when sitting, especially on hard surfaces. Chafing between the inner thighs and scrotal skin becomes more common, particularly during exercise or in hot weather. Some men find that the increased scrotal length makes certain types of underwear uncomfortable or impractical.
There is also a condition sometimes called penoscrotal webbing, where excess scrotal skin extends up along the underside of the penis, making the penis appear shorter. This can worsen with age as scrotal skin loosens further. In more extreme cases, the excess scrotal tissue causes hygiene issues, as the elongated skin folds trap moisture and are harder to clean, raising the risk of fungal infections and irritation.
Pain from the weight of the scrotum pulling on the spermatic cord is uncommon but not unheard of. If you notice a sudden change in how low one or both testicles hang, especially if accompanied by pain, swelling, or a feeling of heaviness, that warrants medical attention. Sudden changes are not typical of normal aging and could signal something else, such as a hydrocele (fluid accumulation around the testis) or an inguinal hernia.
Surgical Options for Scrotal Laxity
When scrotal laxity is bothersome enough to seek treatment, surgery is the most established intervention. The standard procedure is called a scrotoplasty or scrotal reduction, and it involves removing excess scrotal skin and tightening the remaining tissue. A recent case report described a modified technique combining scrotal laxity correction with penoscrotal webbing repair in a single procedure, achieving good cosmetic and functional outcomes with no complications.5PubMed Central. Reduction Scrotoplasty With Concomitant Ventral Phalloplasty: Rethinking the Approach to a Common Urological Condition
Beyond full surgery, some practitioners have explored less invasive options. Absorbable suspension sutures have been suggested as a potential way to provide a temporary scrotal lift without major excision.1PubMed Central. Scrotal Rejuvenation Various energy-based devices, such as radiofrequency and laser treatments used for skin tightening elsewhere on the body, have been discussed in the context of scrotal rejuvenation, though evidence for their effectiveness on scrotal skin specifically remains limited. The scrotal skin is thinner and more vascular than skin on most other body parts, which makes applying cosmetic skin-tightening technologies more complicated.
Most men who seek treatment are motivated by a combination of functional complaints and cosmetic dissatisfaction. Insurance coverage for scrotal reduction varies widely and usually requires documentation of functional impairment rather than purely cosmetic concern.
Factors That Speed Up or Slow Down the Process
Genetics play a large role. Just as some men lose scalp hair rapidly while others retain a full head into their seventies, baseline scrotal skin elasticity and connective tissue resilience vary between individuals. Some men in their sixties have a scrotum that has barely changed from their thirties; others notice significant laxity by their late forties.
Body weight matters, too. Carrying excess weight in the lower abdomen and groin increases heat exposure to the scrotal area and adds mechanical stress to scrotal skin from friction and pressure. Conversely, significant weight loss can leave behind loose skin throughout the body, and the scrotum is no exception. Men who lose a large amount of weight sometimes notice pronounced scrotal laxity even at relatively young ages.
Chronic heat exposure may accelerate changes. Men who frequently use saunas, hot tubs, or spend long periods in hot environments expose their scrotal skin to repeated cycles of stretching and relaxation. Over time, this could contribute to earlier loss of elastic recoil, though no controlled study has specifically measured the effect of chronic heat exposure on long-term scrotal length. Tight clothing that holds the scrotum against the body all day theoretically reduces gravitational stretching but increases heat exposure, so the net effect on long-term laxity is unclear.
Smoking accelerates collagen breakdown throughout the body, and there is no reason to think scrotal skin would be exempt. The same goes for excessive sun exposure on any skin that receives it, though the scrotum is not typically sun-exposed for most men.
The Asymmetry Question
Many men notice that one testicle hangs lower than the other, and they sometimes wonder whether aging makes this difference more pronounced. Testicular asymmetry is present from puberty onward in most men. The left testicle typically hangs slightly lower than the right, a pattern attributed to differences in the blood vessel anatomy on each side. The left spermatic vein drains into the left renal vein at a roughly perpendicular angle, creating more hydrostatic pressure than the right side, which drains more directly into the large vena cava.
With age, as the overall scrotal position drops, the absolute distance between the two testes may appear to increase slightly, but the relative asymmetry usually does not change dramatically. If you notice a sudden increase in asymmetry, particularly on one side, that could indicate a hydrocele, varicocele, or other localized issue rather than normal aging.
Why Testicles Hang Outside the Body at All
The fact that testicles are external in the first place is something of an evolutionary puzzle. Not all mammals have a scrotum. Elephants, some marine mammals, and a number of other species keep their testes inside the body and produce sperm just fine. So why did scrotal descent evolve in the mammalian lineage that includes humans?
The traditional explanation centers on temperature: sperm production works better a few degrees below core body temperature, so the testes migrated outside the abdominal cavity to stay cool. But this explanation is somewhat circular, since it does not address why sperm became temperature-sensitive in the first place. Researchers have proposed that the scrotum may have evolved early in the mammalian lineage alongside the development of warm-bloodedness, and that lineages without a scrotum subsequently found alternative cooling solutions rather than never having needed one.6PubMed. The evolution of the scrotum and testicular descent in mammals: a phylogenetic view
One hypothesis proposes that testicular descent serves as a kind of training ground for sperm. By placing the testes in a position with reduced blood supply compared to an internal location, the developing sperm cells are exposed to mild oxygen stress. This may push sperm mitochondria to develop more efficient metabolic machinery, producing fewer but higher-quality sperm cells.7PubMed. The evolution of the scrotum: a new hypothesis Another model suggests that exteriorization evolved partly to temper testosterone production, since Leydig cells in the testes produce less testosterone at the cooler scrotal temperature than they would at core body temperature, potentially avoiding excessive hormonal effects on male development.8PubMed Central. Reappraising the exteriorization of the mammalian testes through evolutionary physiology
None of these hypotheses is settled science. They are not mutually exclusive, either. The evolutionary pressure may have been multifactorial, with temperature sensitivity of sperm, hormonal regulation, and sperm quality all contributing to the fitness advantage of external testes. What is clear is that once the testes moved outside the body, they became subject to gravity and skin aging in a way that internal organs are not, which is why aging affects their position so visibly.
When to Talk to a Doctor
Gradual, symmetrical lowering of the scrotum over years is normal aging. You do not need to see a doctor about it unless it causes functional problems like chafing, pain, or hygiene difficulties. Situations that do warrant medical evaluation include:
- Sudden change: A rapid increase in scrotal size or hang over days to weeks, which could indicate a hydrocele, hernia, or infection.
- Pain or heaviness: A dull ache or feeling of weight that was not there before, especially on one side.
- Visible swelling or lump: Any new mass within the scrotum should be evaluated regardless of age.
- Skin changes: Persistent redness, sores, or darkened spots on scrotal skin. Small raised dark or purplish bumps, called angiokeratomas, are common in older men and typically harmless, but they can occasionally bleed.
If your only concern is the cosmetic appearance, a urologist or a dermatologist familiar with genital skin can discuss options ranging from supportive underwear to surgical correction. There is no medical necessity to treat normal age-related scrotal laxity, but there is also no reason to be embarrassed about seeking help if it bothers you. The procedures exist because enough men find the change uncomfortable or distressing to create demand for solutions.