HIV is the leading healthcare issue addressed within our community. Our lives seem to be dictated around this single illness, either how to avoid it or our treatment if/when we test positive. The concern over sexually transmitted diseases is reasonable, but we must not forget that, as gay males, we are still human and male. This means we are susceptible to the same diseases and illnesses as the rest of the male human population, and this includes CANCER.

Not much research has been collected relating specifically to gay males and cancer, but the information about males is pretty strong. It is essential to remember our maleness and gayness as risk factors for health concerns.

At this point, we all should know the basics about the significant cancers like lung and prostate, but we don’t hear much about rarer ones that are life-threatening and usually not caught early enough. One of the least talked about is testicular cancer. This is primarily an illness of the young, but older men also contract it. This one should be pretty easy to detect and get treated if you know your body and your balls well. We gathered our information from the experts in the cancer field, The American Cancer Society (ACS). GMJ culled its data banks to answer your most prominent and pressing concerns about this illness. As usual, link-backs are provided so that you may further your education.

NOTE: Often, in porn or among our friends, it is common to hear about how large a guy’s balls are; bull balls, big as grapefruits, the size of apples..etc. These are just words and fantasy. In real life, these would be signs of serious illness. Don’t take things so literally.

Pro Tip: Masturbation is a great time to get off and learn more about your body and genitals. Don’t ignore it if you feel or see something unusual or out of place! Changes in your nuts, like hard or swollen knobs, are easily detected when jerking off or taking a bath/shower. Use your time wisely. 

Testicular Cancer:

The American Cancer Society’s estimates for testicular cancer in the United States for 2017 are:

  • About 8,850 new cases of testicular cancer diagnosed
  • Approximately 410 deaths from testicular cancer

The incidence rate of testicular cancer has been increasing in the United States and many other countries for several decades. The increase is mostly in seminomas, and experts have not been able to find reasons for this increase. Lately, the rate of growth has slowed.

Testicular cancer is not common; about 1 of every 263 males will develop testicular cancer during their lifetime.

The average age at the time of diagnosis of testicular cancer is about 33. This is largely a disease of young and middle-aged men, but about 7% of cases occur in children and teens, and about 7% occur in men over 55.

Because testicular cancer usually can be treated successfully, a man’s lifetime risk of dying from this cancer is very low: about 1 in 5,000. If you want to know more about survival statistics, see Testicular cancer survival rates.


Most testicular cancers can be found at an early stage. In some men, early testicular cancers cause symptoms that lead them to seek medical attention. Most of the time, a lump on the testicle is the first symptom, or the testicle might be swollen or larger than usual. But some testicular cancers may not cause symptoms until they have reached an advanced stage.

Testicular self-exam

The best time to examine your testicles is during or after a bath or shower, when the skin of the scrotum is relaxed.

  • Hold your penis out of the way and examine each testicle separately.
  • Hold your testicle between your thumbs and fingers with both hands and roll it gently between your fingers.
  • Look and feel for any hard lumps or nodules (smooth rounded masses) or any change in the size, shape, or consistency of your testicles.

It’s normal for one testicle to be slightly larger than the other and for one to hang lower than the other. You should also be aware that each normal testicle has a small, coiled tube called the epididymis that can feel like a small bump on the upper or middle outer side of the testis. Normal testicles also contain blood vessels, supporting tissues, and tubes that carry sperm. Some men may confuse these with abnormal lumps at first. If you have any concerns, ask your doctor.

A testicle can get larger for many reasons other than cancer. For example, fluid can collect around the testicle to form a benign condition called a hydrocele. Or the veins in the testicle can dilate and cause enlargement and lumpiness around the testicle. This is called a varicocele. If your testicle seems larger, have a doctor examine you to be sure you have one of these conditions and not a tumor. The doctor may order an ultrasound exam (see How is testicular cancer diagnosed?). This is an easy and painless way of finding a tumor.

Risk Factors

Scientists have found few risk factors that make someone more likely to develop testicular cancer. Even if someone has one or more risk factors for this disease, it’s impossible to know for sure how much that risk factor contributes to developing cancer. Also, most boys and men with testicular cancer do not have any of the known risk factors. Risk factors for testicular cancer include:

  • An undescended testicle
  • Family history of testicular cancer
  • HIV infection
  • Carcinoma in situ of the testicle
  • Having had testicular cancer before
  • Being of a particular race/ethnicity
  • Body size


  • Some men with testicular cancer have no symptoms at all, and their cancer is found during medical testing for other conditions. Sometimes imaging tests to find the cause of infertility can uncover a small testicular cancer.
  • Lump or swelling in the testicle

Most often, the first symptom of testicular cancer is a lump on the testicle, or the testicle becomes swollen or larger. (It’s normal for one testicle to be slightly larger than the other and for one to hang lower than the other.) Some testicular tumors might cause pain, but most of the time, they do not. Men with testicular cancer can also feel heaviness or aching in the lower abdomen or scrotum.

  • Breast growth or soreness

In rare cases, germ cell tumors can make breasts grow or become sore. This occurs because certain germ cell tumors secrete high levels of a hormone called human chorionic gonadotropin (HCG), which stimulates breast development.

Some Leydig cell tumors can make estrogens (female sex hormones), which can cause breast growth or loss of sexual desire.

  • Early puberty in boys

Some Leydig cell tumors can make androgens (male sex hormones). Androgen-producing tumors may not cause specific symptoms in men, but in boys, they can cause signs of puberty at an abnormally early age, such as a deepening voice and facial and body hair growth.

Symptoms of advanced testicular cancers

Even if testicular cancer has spread to other body parts, many men might not have symptoms immediately. But some men might have some of the following symptoms:

  • Low back pain from cancer spreads to the lymph nodes (bean-sized collections of immune cells) in the back of the belly
  • Shortness of breath, chest pain, or a cough (even coughing up blood) may develop from lung cancer.
  • Belly pain, either from enlarged lymph nodes or because the cancer has spread to the liver.
  • Headaches or confusion from cancer spread in the brain.
  • Several non-cancerous conditions, such as testicle injury or inflammation, can cause symptoms similar to testicular cancer.
  • Inflammation of the testicle (known as orchitis) and inflammation of the epididymis (epididymitis) can cause swelling and pain in the testicle. Both of these also can be caused by viral or bacterial infections.


Depending on the type and stage of the cancer and other factors, treatment options for testicular cancer can include:

In some cases, more than one type of treatment might be used.

Depending on the stage of your cancer and your treatment options, you may have different types of doctors on your treatment team. These doctors may include:

  • A urologist: a surgeon who specializes in treating diseases of the urinary system and male reproductive system
  • A radiation oncologist: a doctor who treats cancer with radiation therapy
  • A medical oncologist: a doctor who treats cancer with medicines such as chemotherapy

Many other specialists might also be involved in your care, including physician assistants, nurse practitioners, nurses, physical therapists, social workers, and other health professionals. See Health Professionals Associated With Cancer Care for more on this.

What if one or both testicles need to be removed? 

The surgeon makes a small cut in your scrotum (the sac which holds your testicles). After removing your testicles, your surgeon may put in fake testicles (prostheses) so that your scrotum looks and feels the same.  You may be able to have a minor operation to remove only the inner part of your testes. This is a subcapsular orchidectomy; you don’t need a prosthesis after this operation.

You may have some discomfort after the operation. You will have a few stitches on your scrotum. Usually, these are absorbable. So, they don’t need removal. You may go home the same day or stay in the hospital overnight.

  • You can still successfully achieve an erection and ejaculate with one testicle.
  • If both are removed, you will need hormone replacement therapy for the loss of testosterone.
  • You can retain a normal sex life.
  • Realistic testicular prostheses exist to replace the ones surgically removed.

LGBT focused support

If you are diagnosed with testicular or any cancer, you may want to reach out to gay-specific organizations. Here are two that we found helpful.

Founded in 2005, The National LGBT Cancer Project and Out With Cancer constitute the first national LGBT cancer survivor support and nonprofit advocacy organization in the United States.
Known collectively as the National LGBT Cancer Project, we provide cancer-related programs, services, and research focused on lesbian, gay, bisexual, transgender, and intersex people and other sexuality and gender-diverse people and communities.

The National LGBT Cancer Network works to improve the lives of LGBT cancer survivors and those at risk by:

  • EDUCATING the LGBT community about our increased cancer risks and the importance of screening and early detection;
  • TRAINING health care providers to offer more culturally competent, safe and welcoming care; and
  • ADVOCATING for LGBT survivors in mainstream cancer organizations, the media, and research.

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