The scrotum does tend to hang lower as men age, though the testicles themselves are not “dropping” in the way they first descended during fetal development. What changes over decades is the support system around them: the scrotal skin loses elasticity, the small muscles responsible for pulling the scrotum upward lose tone, and hormonal shifts reduce the tension that keeps everything snug. The result is a noticeable sag that most men observe by middle age or later, and it is almost always a normal part of aging rather than a sign of something wrong.
The Muscles That Hold Everything in Place
The scrotum is not a passive pouch. It is a dynamic structure that constantly adjusts the position of the testicles. Two muscles do most of the work. The dartos muscle sits within the scrotal wall itself and contracts to wrinkle and tighten the skin. The cremaster muscle wraps around each spermatic cord and can pull the testicle upward toward the body.
Both muscles respond to temperature. In cold conditions, they contract to draw the testicles closer to the body, keeping them warm. In heat, they relax and let the scrotum hang lower, moving the testicles away from core body warmth. This thermoregulation happens because sperm production requires temperatures a few degrees below the body’s internal temperature. Research on scrotal temperature during physical activity has confirmed that the dartos muscle contracts in response to noradrenaline released during sympathetic nervous system activation, while the cremasteric reflex can be triggered by mechanical stimulation of the inner thigh, both of which pull the testicles upward during exercise.
When you are young, this system is responsive and keeps the scrotum relatively tight much of the time. With age, both muscles gradually lose their contractile strength, and the scrotum spends more time in a relaxed, lower-hanging state.
Why the Scrotum Sags With Age
Several overlapping processes drive the change. The most visible is skin aging. Like skin everywhere else on the body, scrotal skin loses collagen and elastin over time. But scrotal skin is unusually thin and heavily folded, which makes laxity more pronounced than on, say, a forearm. Dermatologists who study the area describe age-related scrotal changes as including increased wrinkling and laxity, alongside vascular changes like small cherry-red spots called angiokeratomas.1PubMed Central. Scrotal Rejuvenation
Beneath the skin, the dartos muscle weakens. Animal research has shown that the dartos muscle’s ability to maintain resting tension in cold conditions depends on a temperature-sensitive receptor called TRPM8, and that expression of this receptor in dartos cells requires a functional androgen receptor.2PubMed Central. Temperature-dependent contractility of rat tunica dartos muscle: Contribution of cold, menthol-sensitive TRPM8 In plain terms, testosterone helps the dartos muscle stay responsive to cold and maintain its baseline tone. As testosterone levels decline with age, the muscle’s resting tension drops, and the scrotum hangs looser by default.
The cremaster muscle follows a similar trajectory. It is a skeletal muscle, meaning it is under partial voluntary and reflex control, and like other skeletal muscles it loses mass and responsiveness with age. The cremasteric reflex, which you can observe by lightly stroking the inner thigh and watching the testicle on that side retract upward, tends to become sluggish or absent in older men. Gravity does the rest: without active muscular opposition, the weight of the testicles steadily stretches the supporting tissues.
How Testicles Actually Descend in the First Place
The phrase “testicles dropping” usually refers to what happens during fetal development and early infancy, and it is a completely different process from the age-related sag described above. During pregnancy, the testicles form inside the abdomen near the kidneys. A hormone called insulin-like peptide 3 (INSL3) causes a ligament called the gubernaculum to thicken, anchoring the testicles near the groin while the rest of the abdominal organs grow upward and away. This first phase positions the testicles at the inguinal canal. A second phase follows later in pregnancy, when the testicles pass through the inguinal canal and settle into the scrotum.3PubMed Central. Expression and Role of INSL3 in the Fetal Testis
In most boys, both testicles are fully descended by birth or within the first few months of life. When one or both fail to descend, the condition is called cryptorchidism, and it usually requires medical intervention. This developmental descent is a one-time event. It is not something that repeats or reverses in adulthood, so when men notice their scrotum hanging lower over the years, they are not experiencing a second “drop.” They are experiencing tissue aging.
Testicles That Move Back Up in Childhood
Interestingly, testicles can actually travel in the opposite direction during childhood. Some boys have what are called retractile testicles, where the testicle moves freely between the scrotum and the inguinal canal, often pulled upward by an overactive or structurally different cremaster muscle. Research has suggested that rather than a hyperactive cremasteric reflex, the retractile condition may result from changes within the cremaster muscle itself.4PubMed. Cremasteric reflex and retraction of a testis
In some cases, a testicle that was previously in a normal scrotal position can ascend and become stuck higher up, a condition known as acquired undescended testis. A study of over 300 cases found that in boys where a prior normal position had been documented, the ascent occurred between ages one and fourteen, with half of the cases ascending by about age six.5PubMed. Acquired undescended testis: When does the ascent occur? This is a pediatric concern and unrelated to age-related scrotal laxity in adults, but it is worth knowing about because it complicates the tidy story that testicles descend once and stay put forever.
Varicoceles and Other Changes That Come With Age
A lower-hanging scrotum is not the only change men may notice as they get older. Varicoceles, which are enlarged veins within the scrotum similar to varicose veins in the legs, become more common with age. A study of men in an elderly population found varicoceles present in about 42% of subjects, higher than rates typically reported in younger men.6Urology. Prevalence and effect of varicoceles in an elderly population Most varicoceles occur on the left side due to the anatomy of venous drainage, and many cause no symptoms at all. When they do, men usually describe a dull ache or a feeling of heaviness in the scrotum, particularly after standing for long periods.
Spermatoceles are another age-related finding. These are fluid-filled cysts that develop near the epididymis, the coiled tube sitting behind each testicle. Most are small, painless, and discovered incidentally during a physical exam or ultrasound. Occasionally they grow large enough to cause discomfort or visible swelling.7Journal of Case Reports and Images in Urology. Huge multilocular spermatocele in a patient with left scrotal swelling Hydroceles, which are collections of fluid around the testicle rather than in a cyst, are similarly common in older men and can contribute to the sense that the scrotum is hanging differently than it used to.
None of these conditions are dangerous on their own, but all of them can change how the scrotum looks and feels. A man who notices new heaviness, asymmetry, or swelling should get it checked, not because low-hanging testicles are inherently worrisome, but because the change might reflect one of these specific conditions rather than simple aging.
Does Lower Hanging Affect Fertility or Function?
For younger men, scrotal position matters quite a bit for fertility. The whole purpose of the scrotum’s thermoregulatory system is to keep testicular temperature in the narrow range needed for healthy sperm production. When that system fails, whether from tight clothing, prolonged sitting, fever, or anatomical problems, sperm counts and quality can decline. Mouse studies have demonstrated that sustained heat stress leads to degeneration of the tissue where sperm are made and measurable reductions in spermatogenesis.8Male Reproductive Anatomy. Testicular Histopathology and Spermatogenesis in Mice with Scrotal Heat Stress
For older men whose scrotum hangs lower, the fertility question is less pressing simply because sperm production is already declining for hormonal reasons unrelated to position. Testosterone production decreases gradually starting around age 30, and by the time scrotal laxity becomes noticeable, the hormonal environment is usually the bigger factor influencing reproductive function. That said, a chronically warmer testicular environment from any cause, including varicoceles that pool warm blood around the testicle, can accelerate the decline. The practical takeaway is that scrotal position alone is unlikely to be the make-or-break factor for an older man’s fertility, but it is part of a larger picture of reproductive aging.
Bell-Clapper Deformity and Torsion Risk
One structural issue related to testicular mobility deserves attention, though it is not strictly an aging phenomenon. Bell-clapper deformity is a congenital condition where the normal attachment between the testicle and the back wall of the scrotum is absent or incomplete. This gives the testicle much more freedom to rotate within its surrounding membrane, increasing the risk of testicular torsion, a painful emergency where the spermatic cord twists and cuts off blood flow.9Urology. Testicular Torsion From Bell-clapper Deformity
Torsion is most common in adolescents and young adults, and it becomes rarer with age as the testicle becomes more firmly attached to surrounding tissue. However, it can happen at any age, and increased scrotal laxity may theoretically allow more testicular movement in men who have an undiagnosed bell-clapper deformity. Any sudden, severe testicular pain warrants immediate medical attention regardless of age, because torsion can cause permanent damage within hours if the blood supply is not restored.
Testicular Size Changes Over Time
Beyond position, the testicles themselves can change in size with age. Some degree of volume loss is normal in older men, driven by the same hormonal shifts that affect the rest of the reproductive system. But significant shrinkage, known as testicular atrophy, can also result from specific medical conditions. Ultrasound studies have documented small testes associated with a range of causes including prior infections like mumps orchitis, prior torsion events, varicoceles, and genetic conditions.10PubMed Central. Small testes: clinical characteristics and ultrasonographic findings
A man who notices that one testicle seems noticeably smaller than it used to be, or that both feel softer and smaller, should mention it at a routine checkup. It may be nothing more than normal aging, but it can also be an early sign of hormonal insufficiency or a consequence of an old injury. Combined with a lower-hanging scrotum, testicular atrophy can make the overall appearance change more dramatically than either process alone would.
Cosmetic Concerns and Surgical Options
For some men, the aesthetic changes are bothersome enough to seek treatment. Scrotal laxity can cause chafing, discomfort during exercise, or simply self-consciousness. The most established treatment for significant scrotal laxity is surgical, typically a procedure called scrotoplasty or scrotal reduction, where excess skin is removed and the remaining tissue is tightened.1PubMed Central. Scrotal Rejuvenation Some practitioners have explored absorbable suspension sutures as a less invasive option to provide a scrotal lift, though this approach is newer and less well studied.
These procedures are elective and primarily cosmetic. They do not restore the thermoregulatory function of the dartos or cremaster muscles, and they do not reverse hormonal changes. For men whose main complaint is mild sag, supportive underwear is the simplest and most common solution. Briefs or athletic supporters hold the scrotum closer to the body, reducing the discomfort of excessive movement and the chafing that can come with it. For men with more extreme scrotal enlargement caused by conditions like lymphedema or elephantiasis, surgical reduction becomes more of a functional necessity than a cosmetic preference, and techniques for managing very large scrotal masses have been described in the surgical literature.11Indian Journal of Surgery. Reduction Scrotoplasty in 100 kg Scrotums
What Warrants a Doctor Visit
Gradual, symmetrical scrotal sag over years or decades is almost certainly normal aging. But several patterns should prompt a conversation with a doctor:
- Sudden change: If the scrotum becomes noticeably heavier or more swollen over days or weeks rather than years, this could indicate a hydrocele, hernia, or infection rather than normal aging.
- Pain or tenderness: Age-related laxity is painless. Persistent aching, especially on one side, can point to a varicocele, epididymitis, or in rare cases a tumor.
- Visible asymmetry: Some degree of asymmetry is normal, as one testicle typically hangs slightly lower than the other. A new or dramatic difference in size or position is worth investigating.
- Lump or hard spot: Any new firm mass within the testicle itself, as opposed to the surrounding structures, needs prompt evaluation. Testicular cancer is most common in younger men but can occur at any age.
- Skin changes: Small dark-red spots on the scrotal skin are usually angiokeratomas, which are harmless dilated blood vessels. But any rapidly changing skin lesion deserves medical review.
Regular self-exams in the shower, when the scrotum is warm and relaxed, remain the easiest way to notice changes early. Feeling each testicle individually and noting its size, shape, and any lumps takes less than a minute and can catch problems that might otherwise go unnoticed beneath the gradual sag of aging skin.