Effect of Varicocele and Its Treatment on Testosterone in Hypogonadal Men with Varicocele: Review of the Literature

Abstract

Varicocele might cause deterioration in Leydig cell functions, andit is a significant risk factor for hypogonadism. Some controversialissues have been raised in the treatment of hypogonadal men withvaricoceles. Symptomatic hypogonadal men with varicoceleshave two options: testosterone replacement therapy or varicoceletreatment. Both approaches have some advantages and disadvantages.This review summarizes the effect of varicoceles on total plasmatestosterone level and addresses whether varicocele repair is effectiveto improve testosterone levels in hypogonadal men with varicoceles.Experience from large clinical studies in the literature suggests thatvaricocele repair may increase serum testosterone level in men withvaricoceles and testosterone deficiency. Varicocele repair could beoffered to men with clinically palpable varicocele and hypogonadism.As the treatment method, microsurgical varicocele repair couldbe preferred to provide the best improvement. Another advantageof varicocele repair for hypogonadism, instead of exogenoustestosterone treatment, is its ability to preserve the fertility status inmen who may desire a child in the future. However, further studiesare required to clarify varicocel-related Leydig cell dysfunction andto advise hypogonadal patients about the sufficient effectiveness ofvaricocele repair.