You may have heard of the social media trend known as ‘looksmaxxing,’ an online subculture focused on ‘maximizing’ physical attractiveness. A newer trend called ‘ballmaxxing’ falls under this category and has now gained attention in the men’s body modification arena.

Ballmaxxing is when a man self-injects saline or Surgilube into the scrotum to temporarily increase its size. Some men report injecting fluids until their scrotum is the size of a grapefruit or larger. 

Yet, neither fluid was intended for this purpose. Surgilube, in particular, cannot be broken down and eliminated, meaning it cannot reabsorb into the body as saline can.

“Neither substance is intended for injection into the testicle or scrotum for augmentation,” says urologist and men’s health expert Chris Deibert, MD. “In urology, normal saline is used for irrigation or intraoperatively for planning purposes. Surgical lubricant is for external insertion of medical instruments such as scopes or catheters and is not injected or intended to remain in the body.”

Anatomy check: Testicles vs. scrotum

Certain articles make it seem like the terms testicles and scrotum are interchangeable. Let’s clarify. 

The testicles are two egg-shaped organs inside the scrotum. A complex structure, the testicles make sperm and the hormone testosterone. 

The scrotum is the pouch of skin that holds the testicles, allowing them to move closer to the body for warmth or farther away to cool off. This area is not only sensitive, but also contains delicate structures such as blood vessels and nerves.

“The scrotum has significant capacity for fluid, making temporary inflation possible,” says Dr. Deibert. “But the testicle is a dense organ with no potential space for fluid, so these enlargements reflect scrotal sac infusion, not testicle enlargement. Still, I don’t think there’s a safe way to inject surgical lube or saline into your scrotum or your testicle.” 

A fair question remains: What are men risking, and further, what happens if their attempt goes wrong?

Safety and risks

There are various personal reasons why some men report positivity about ballmaxxing, but there are also safety concerns associated with these trends. Are they harmful to men’s health? Here are several issues and risks to consider.

How products are acquired and used.

Many are ordering online kits – or potentially worse – getting supplies from an underground source. Since ballmaxxing happens at home, there’s no assurance of a sterile environment, sterile products, regulated, medical-grade or nontoxic fluids, or the medical expertise to perform the procedure.

The potential physical risks.

Risks of injecting into the testicle:

• Compromised blood flow leading to testicular atrophy. Direct injury can cut off blood flow, causing the testicle to shrink and die.
• Infertility due to reduced sperm production or damage to the testicle.
• Infection.
• Low testosterone due to reduced hormone production. 
• If atrophy lowers testosterone levels, secondary erectile dysfunction could occur.
• Severe pain due to the highly sensitive area.

Risks of injecting into the scrotum:

• Infection, abscess, cellulitis or potential sepsis from non-sterile materials or repeated injections.
• Temporary effects, with saline absorbed within 24 to 48 hours, requiring constant re-injection for maintenance.
• Repeated punctures are suspected to increase infection risk.

Do the temporary benefits outweigh the risks?

“As a concept, the practice is risky, but there’s no real data yet on outcomes or complication rates,” adds Dr. Deibert. “Still, my counsel to patients would be to avoid this practice, especially given the short-lived results and procedure risks. There is no positive or medical benefit to ballmaxxing. It is not a safe or effective treatment for testicular atrophy, nor does it provide any improvement in testosterone, fertility or sexual function. The only payoff is a very temporary larger scrotum.”

Is there a safe way to enlarge?

Testicular atrophy is something men can experience, especially with aging, low hormone levels or medical conditions. While no procedure reliably increases testicle or scrotum size for cosmetic reasons, Dr. Deibert offers some advice.

“See a urologist for an evaluation. Medically confirmed testicular atrophy may respond to Human Chorionic Gonadotropin (HCG) injections given subcutaneously (not into the scrotum or testicle). This treatment may help reverse true medical atrophy. Testicular implants exist, but mainly only after testicle loss from cancer or injury, not for cosmetic enlargement.”