The impact of varicocele and varicocele repair on serum testosterone

The increased risk of infertility in men with varicocele is well established. Varicocelectomy has been shown to improve semen parameters and increase pregnancy rates. Yet varicocele pathophysiology is poorly understood and potential implications for testosterone production are less clear. Evidence suggests that varicocele may result in lower serum testosterone levels and that varicocelectomy may, in turn, correct this deficit.

Several studies published in the past 18 months have assessed the effect of varicocele and varicocelectomy on serum testosterone levels. These include data gathered from two rat models of varicocele induction and outcomes after repair. Of additional interest is a study of serum testosterone levels in men after varicocelectomy, the first of its kind to stratify data by patient age and to address whether varicocele repair is effective in improving testosterone levels in older men.

Definitive statements regarding varicocele, varicocelectomy, and testosterone are difficult to make given the frequent absence of control groups and lack of sample group consistency. Despite this, recent well done animal and human studies suggest an adverse effect of varicocele on testosterone and a potential benefit of varicocele repair. Further controlled studies examining testosterone as a primary data point are required.