Why 'Ballmaxxing' May Be More Dangerous Than You Think

• “Ballmaxxing” is a viral social media phenomenon in which fluids are injected into the testicles to increase their size.
• Some men are injecting fluids until their testicles become the size of grapefruits.  
• Experts caution that ballmaxxing could cause infection and may result in long-term damage to male genitalia. 

There is no shortage of “maxxing” trends on social media, from “looksmaxxing” to “fibermaxxing” to “sleepmaxxing.”

The latest, known as “ballmaxxing,” has men injecting fluids like saline or Surgilube into their testicles to increase their size. Some proponents say that ballmaxxing helped inflate their testicles to the size of grapefruits.

But the question on everyone’s mind is, “Why?” 

Some say that increasing their scrotum size makes them feel more masculine and confident, while others claim they believe women prefer larger testicles. Some have also suggested that ballmaxxing can enhance sexual pleasure and performance. 

However, saline and Surgilube were not intended for these purposes.

Saline is a sterile solution of sodium chloride in water used for medical and health reasons. Surgilube is a sterile, water-soluble surgical lubricant used clinically to facilitate the insertion of medical instruments, catheters, and endoscopes. Both fluids are intended for external medical use and instrument lubrication. Why they’ve been repurposed for ballmaxxing is unclear.

Whatever the reason, experts warn that ballmaxxing may cause more harm than good.

“Physicians have called ballmaxxing one of the most reckless body modification trends to emerge from male online communities, warning that the temporary size increase often leads to permanent damage,” said Robert Glatter, MD, attending physician in the Department of Emergency Medicine at Lenox Hill Hospital in New York City, and Assistant Professor of Emergency Medicine at Zucker School of Medicine at Hofstra/ Northwell.

Healthline spoke with Glatter to learn more about this potentially dangerous trend. 

This interview has been lightly edited for clarity and length. 

Is ballmaxxing safe? 

Glatter: The short answer: The scrotum was not built for this. The area is extremely sensitive and contains delicate structures — including the testicles, blood vessels, and nerves — that are simply not designed to accommodate fluid distension.  

Specific risks include infection, abscess formation, and cellulitis from the introduction of unregulated fluid outside a medical setting. Pressure from fluid accumulation may also impair blood flow, potentially affecting testicular function — in other words, the very organs someone is trying to “enhance” can be permanently damaged in the process.  

Most ballmaxxing happens at home with kits bought online, with no sterile field and no trained operator, making sepsis a potential and serious outcome. 

Others may purchase materials from underground sources, which may contain toxic materials that are not only harmful but also unsterile, increasing the risk of severe infection, sepsis, and the need for surgical intervention with potential permanent disfigurement.

Can saline injections cause permanent damage?

Glatter: Even medical-grade saline, when injected outside a clinical setting by an untrained individual, carries serious risks. 

Without proper sterile technique, you are essentially introducing bacteria directly into a warm, enclosed anatomical space — ideal conditions for a rapidly spreading infection, death of tissue, requiring surgical debridement and potentially scrotal removal or resection in the setting of impending necrotizing fasciitis, a potentially fatal condition if not recognized and treated immediately with surgical intervention and aggressive IV antibiotics. 

Surgilube compounds this further: it is not bioabsorbable, meaning the body cannot break it down and eliminate it, unlike saline, which it can eventually reabsorb. The result can be persistent foreign body reactions, disfigurement, and the need for surgical intervention to remove embedded material.

Simply put, it is not intended for injection into body tissue. Injecting a viscous lubricant into scrotal tissue introduces a foreign substance that the body has no mechanism to absorb or clear, raising the risk of granuloma formation (localized area of inflammation), chronic inflammation, and necrosis (tissue destruction) on top of all the infection risks saline alone already poses.

What are some proven ways to help enlarge testicles?

Glatter: [Safer strategies] involve going to see a board certified urologist for evaluation.

Testicular atrophy is a real phenomenon that can accompany aging, low testosterone levels, or certain medical conditions. Evaluation often begins with a testicular ultrasound to check for anatomical issues that could contribute to a smaller testicular size.

Next, evaluation of testosterone, FSH (follicle-stimulating hormone), LH (Luteinizing hormone), and thyroid hormone levels by a urologist in conjunction with an endocrinologist is the appropriate starting point. 

Testosterone replacement therapy (TRT), when medically indicated, can help preserve testicular volume, though it paradoxically suppresses natural testosterone production and can reduce testicular size in some cases — a nuance worth discussing with an endocrinologist and urologist.

For males concerned about aesthetic appearance after significant volume loss (for example, following orchiectomy or surgical removal of a testicle), prosthetic testicular implants are a legitimate surgical option performed by trained urologists in sterile operating environments.