Scrotal hang depends mostly on the involuntary muscles that surround the testicles, and the most reliable way to get a lower hang is to relax those muscles, either temporarily through warmth and relaxation or more durably through medical procedures like botulinum toxin injections or surgical scrotoplasty. The scrotum is not a passive sack; it is an active thermoregulatory organ with its own set of muscles constantly adjusting position. Understanding how those muscles work reveals which approaches actually change scrotal hang and which are wishful thinking.
The Muscles That Control Scrotal Position
Two muscle systems are responsible for pulling your testicles up toward your body or letting them drop. The cremaster muscle, which runs along the spermatic cord, lifts each testicle individually. The dartos muscle is a thin sheet of smooth muscle embedded in the scrotal skin itself, and it contracts to wrinkle and tighten the entire scrotum. The dartos reflex is driven by the sympathetic nervous system and responds to temperature, touch, and emotional state.1Spinal Cord Series and Cases. Dartos reflex as autonomic assessment in persons with spinal cord injury When you are cold, anxious, or startled, both systems contract, pulling everything snug against the body. When you are warm and relaxed, they let go, and the scrotum hangs lower.
This system exists because sperm production requires a temperature a few degrees below core body temperature.2Sri Lanka Journal of Obstetrics and Gynaecology. A review of scrotal temperature regulation and its importance for male fertility The scrotum acts like a biological thermostat, drawing the testes closer to the warmth of the abdomen when it is cold and dropping them away when temperatures rise. Every man experiences this cycle daily. It is the single biggest factor determining where your testicles sit at any given moment.
Warmth and Relaxation as Simple Approaches
Because the dartos and cremaster muscles relax in response to heat, the simplest way to get a lower hang is to warm the area. A warm bath, a hot shower, or simply being in a warm room will cause the scrotum to relax and elongate within minutes. This is not a permanent change; it reverses as soon as you cool down. But it is the mechanism behind the common observation that scrotal hang varies dramatically between, say, stepping out of a hot tub and walking through cold air.
Some men try prolonged warm-water soaking as a deliberate strategy. Research on warm water exposure in animal models found that moderate temperatures (around 30–35°C) did not harm sperm production, while water at 40°C did begin to interfere with spermatogenesis.3ResearchGate / Journal of Complementary and Alternative Medical Research. Effect of Warm Water Bathe on the Testes and Sperm Quality of Adult Wistar Rats This is an important caution: you can relax the scrotum with warmth without risking fertility, but pushing the temperature too high crosses into territory that can damage sperm. A comfortably warm bath is fine; prolonged exposure to very hot water is not.
Loose-fitting underwear and clothing also matter. Tight briefs hold the scrotum close to the body, preventing the muscles from fully relaxing even in warm conditions. Switching to boxers or going without underwear removes that mechanical constraint. Again, these are temporary lifestyle factors, not permanent changes, but they are the lowest-risk starting point.
Stretching and Manual Techniques
Online forums are full of advice about manual scrotal stretching, often involving pulling on the scrotum regularly over weeks or months. There is no peer-reviewed research supporting manual stretching as a method for permanently increasing scrotal hang. The scrotal skin does have some elasticity, and skin generally can adapt to sustained tension over long periods (the principle behind tissue expansion in reconstructive surgery), but there is a large gap between a surgeon-controlled medical procedure and someone tugging on their scrotum at home.
The risks are worth considering. Repeated forceful pulling can cause microtears, bruising, or irritation. The dartos muscle may actually respond to the stimulus by contracting more, the opposite of the intended effect. Without any clinical evidence showing this works, manual stretching falls into the category of unproven folk methods. If the goal is a sustained change in scrotal appearance, the approaches with actual evidence behind them are medical ones.
Botulinum Toxin Injections
Injecting botulinum toxin (commonly known by its brand name Botox) into the scrotal dartos muscle is the most talked-about medical option for achieving a lower, smoother hang. The concept is straightforward: botulinum toxin temporarily paralyzes muscle fibers, preventing the dartos from contracting. Without that contraction, the scrotum stays relaxed and elongated.
A case report in the urology literature documented the results of intrascrotal botulinum toxin injection, finding that about ten days after the procedure the cremaster muscle was relaxed, the scrotum appeared deployed (hanging more loosely), and the patient reported a softer, smoother scrotum with the testicles appearing larger. The patient was described as very satisfied with the cosmetic result.4Progrès en Urologie. Intrascrotal injection of botulinum toxin A, a male genital aesthetic demand: Technique and limits Botulinum toxin for scrotal wrinkling has also been discussed in reviews of scrotal rejuvenation as a hypothesized treatment for dartos-driven tightening and wrinkling.5PubMed Central. Scrotal Rejuvenation
The effect is temporary. Botulinum toxin wears off in roughly three to four months as the nerve endings regenerate, which means repeat injections are needed to maintain the result. The procedure is done in a clinical setting and is not widely offered; you would need to find a urologist or cosmetic surgeon experienced with genital aesthetics. Side effects can include bruising, temporary discomfort, and the small but real risks associated with any injection near sensitive anatomy. There are no large clinical trials establishing long-term safety of repeated scrotal botulinum toxin use, so anyone considering this should go in with realistic expectations about the evidence base.
Surgical Options
For men whose concern is the opposite problem, excess scrotal skin and too much hang, surgery called reduction scrotoplasty trims redundant tissue. But surgical techniques also exist that can address scrotal contour more broadly. A systematic review of aesthetic scrotoplasty proposed algorithms for managing bothersome scrotal appearance, including vertical midline skin resection for excess tissue and Z-plasty techniques for penoscrotal webbing.6PubMed. Aesthetic Scrotoplasty: Systematic Review and a Proposed Treatment Algorithm for the Management of Bothersome Scrotum in Adults Another systematic review characterized scrotoplasty techniques as generally safe and effective for improving genital cosmesis.7International Journal of Impotence Research. Reconstructive surgery of the scrotum: a systematic review
If the goal is specifically a lower hang rather than a tighter one, surgery is less commonly sought. The surgical literature focuses more on reduction (removing lax skin) than on elongation. One technique that can produce a lower-hanging result indirectly is correction of penoscrotal webbing, where skin between the base of the penis and the scrotum is released, allowing the scrotum to hang more freely and appear lower.8PubMed Central. Reduction Scrotoplasty With Concomitant Ventral Phalloplasty: Rethinking the Approach to a Common Urological Condition Absorbable suspension sutures have also been proposed as a potential intervention for scrotal lift and contouring, though this remains more theoretical than established practice.5PubMed Central. Scrotal Rejuvenation
The honest picture here is that cosmetic scrotal surgery is a niche field with limited published evidence. Most scrotoplasty papers deal with medical indications like post-surgical reconstruction or correction of congenital abnormalities rather than purely aesthetic requests. If you are considering surgery solely for a cosmetic change in hang, finding a surgeon with documented experience in aesthetic genital procedures is essential, and managing expectations is equally important.
How Hormones Affect Testicular Size
Some men wonder whether testosterone supplementation or other hormonal approaches could change scrotal hang by affecting testicular size. The relationship actually works against you. Exogenous testosterone signals the brain to shut down its own production of the hormones that stimulate the testicles, causing them to shrink. One study found that after four months of testosterone enanthate treatment, testicular volume decreased by roughly 16–19%, directly correlated with declining sperm counts.9PubMed. Effect of testosterone enanthate on testis size Smaller testicles generally do not produce a lower-hanging appearance; if anything, the scrotum may appear less full.
This is a particularly important point for men on testosterone replacement therapy or anabolic steroids who notice their testicles seem to be riding higher or looking smaller. That is not an illusion. The testes are physically shrinking because the body’s internal feedback loop has reduced its own testicular stimulation. Stopping the exogenous testosterone typically allows testicular volume to recover over several months, though the timeline varies.
Normal Variation and When to See a Doctor
Before pursuing any intervention, it helps to know what “normal” actually looks like, because there is enormous variation. In a study of 345 healthy adolescent boys, the left testicle was smaller than the right in about 59% of participants, and roughly 15% had meaningful asymmetry between sides.10PubMed. Testicular asymmetry in healthy adolescent boys One testicle hanging lower than the other is the norm, not the exception. Scrotal hang also changes with age; the dartos muscle and scrotal skin lose elasticity over time, so the scrotum naturally hangs lower in older men than in younger ones.
Some conditions warrant medical attention rather than cosmetic intervention. A retractile testicle, one that moves between the scrotum and the inguinal canal, is common in children and usually resolves on its own. In one long-term follow-up study, about 45% of retractile testes descended normally over time, while roughly 14% eventually required surgical fixation.11Korean Journal of Urology. Long-Term Outcomes of Retractile Testis In adults, a testicle that suddenly retracts and does not come back down, or one accompanied by pain, could signal torsion or another acute problem and needs immediate evaluation.
A hyperactive cremaster reflex, where the testicle pulls up strongly in response to even light touch on the inner thigh, is usually benign but can be annoying. It is more pronounced in some men than others and tends to diminish with age. If it is causing genuine distress, a urologist can evaluate whether any intervention makes sense.
What the Evidence Actually Supports
Pulling together the available research, the approaches that have documented effects on scrotal hang line up like this:
- Warmth: Reliable and immediate, but entirely temporary. A warm environment relaxes the dartos and cremaster muscles, and your scrotum hangs lower for as long as you stay warm.
- Loose clothing: Removes mechanical compression, allowing natural relaxation. Also temporary.
- Botulinum toxin: The only medical intervention with published evidence specifically showing increased scrotal hang. Lasts a few months per treatment. Limited safety data on repeated long-term use.
- Surgery: Effective for reshaping scrotal contour or correcting webbing, but the published literature focuses on reduction rather than elongation. Not a standard procedure for “I want my balls to hang lower.”
- Manual stretching: No published clinical evidence supporting it. Potential for injury.
- Hormones: Exogenous testosterone shrinks testes, working against the goal.
A Long History of Trying
The desire to modify genital appearance is not new. A review of male genital aesthetic surgery noted that since ancient times, men have attempted to change the size and shape of their genitals, with early methods including insect bites, snake venom, and weights. The scientific approach to male genital aesthetics began in the early 1900s and has since expanded to include techniques like scrotoplasty, injectable fillers, and various grafting procedures.12International Journal of Impotence Research. History and future perspectives of male aesthetic genital surgery The field remains relatively small compared to other areas of cosmetic surgery, partly because the anatomy is delicate and outcomes are hard to standardize, and partly because cultural stigma keeps many men from seeking or discussing these procedures openly.
Weights, in particular, have a long informal history. Various cultures and subcultures have practiced scrotal weight-hanging as a body modification technique. As with manual stretching, there is no clinical literature establishing that this is safe or effective. The scrotum does contain elastic tissue that can gradually stretch under sustained load, but the risks include vascular damage, nerve injury, and chronic pain. Anyone tempted by this approach should understand they are operating outside the bounds of anything studied in medicine.
Why Mammals Have External Testes at All
The whole question of scrotal hang only exists because human testes sit outside the body cavity, which is itself an evolutionary puzzle. Most mammals share this arrangement, and phylogenetic analysis suggests that testicular descent into a scrotum is the ancestral condition for placental mammals, not a later adaptation.13PLOS Biology. Loss of RXFP2 and INSL3 genes in Afrotheria shows that testicular descent is the ancestral condition in placental mammals Species that keep their testes internal, like elephants and manatees, are the ones that evolved away from the default. Research mapping scrotal anatomy across the mammalian family tree found that evolution has generally moved from scrotal to progressively more ascrotal arrangements in certain lineages, with complete loss of testicular descent being relatively uncommon.14PubMed. The evolution of the scrotum and testicular descent in mammals: a phylogenetic view
The leading explanation for why external testes persisted is thermoregulation: the enzymes involved in sperm production work best a few degrees below core body temperature, and the scrotum provides the cooling needed to keep that process running. Some researchers have proposed alternative hypotheses, including the idea that external testes signal reproductive fitness or that the arrangement protects sperm DNA from oxidative damage. None of these alternatives has displaced the temperature hypothesis, which remains the most widely supported explanation and the reason your body has all that muscular machinery devoted to raising and lowering the testes in the first place.