Effect of Varicocelectomy on Testosterone Parameters in Hypogonadism: A Systematic Review and Meta-Analysis

Varicocele is a common condition linked to male infertility and testosterone deficiency. Although varicocelectomy is known to improve semen parameters, its effect on testosterone levels in hypogonadal men remains under debate. This systematic review and meta-analysis aimed to evaluate the impact of varicocelectomy on serum testosterone and sexual function parameters in men with hypogonadism.

This study adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and was registered in International Prospective Register of Systematic Reviews (CRD420251016720). A comprehensive literature search was conducted across PubMed, Web of Science, Google Scholar, and ProQuest databases up to March 2025. Studies investigating adults with hypogonadism who underwent varicocelectomy were included. Pooled mean differences (MDs) were calculated using random-effects models. The risk of bias was assessed using the Newcastle-Ottawa Scale and the Joanna Briggs Institute Checklist.

Eighteen studies comprising 1,225 patients with a mean age ranging from late 20s to mid-40s, mainly reported infertility, erectile dysfunction, or low libido; and microsurgical subinguinal varicocelectomy was the predominant technique. Varicocelectomy led to a significant increase in serum testosterone (MD, 113.87 ng/dL; 95% confidence interval [CI], 103-124.75; p<0.00001). Subgroup analysis revealed sustained hormonal improvement at both <6 and ≥6 months postoperatively. Erectile function scores improved significantly (MD, 3.25; 95% CI, 1.49-5.01; p=0.0003). Luteinizing hormone levels decreased slightly (MD, -0.28 mIU/mL; p=0.04), while follicle-stimulating hormone showed no significant change.

Varicocelectomy has been shown to significantly elevate serum testosterone levels and enhance sexual function in hypogonadal men. These findings underscore the potential role of varicocelectomy as a therapeutic option in the management of hypogonadism.