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    Varicocelectomy leads to testosterone increase regardless of grade

    Improvement seen in patients with both bilateral, unilateral varicoceles


    Marc Goldstein, MD, DSc (hon)
    New York—Results from a retrospective review reveal that microsurgical subinguinal varicocelectomy increases serum testosterone levels in men with clinically palpable varicoceles, regardless of varicocele grade.

    First author Wayland Hsiao, MD, a fellow at Weill Cornell Medical College's Center for Male Reproductive Medicine and Microsurgery, New York, presented data from a study exploring the association between varicocele grade and the extent of testosterone improvement post-repair. Although prior work had established that low testosterone levels in men with varicoceles could be improved through varicocelectomy, it was not determined whether the grade (ie, severity) of the varicocele influenced the degree of androgen increase. Such a relationship has been observed between semen quality and varicocele severity, wherein the higher the varicocele grade, the larger the increase in semen quality following repair.

    Pre- and postoperative total serum testosterone levels and semen analyses were obtained from 67 men who underwent varicocelectomy to treat infertility and/or hypogonadism. Men with unilateral grade 1 varicoceles or men who were receiving medical treatment for hypogonadism were not included in the analysis. Study participants were stratified by varicocele grade and location (ie, unilateral versus bilateral).

    The majority of men underwent bilateral varicocelectomy (51 of 67), with the remaining 16 men treated for a grade 2 or 3 unilateral left varicocele.

    Mean serum testosterone levels for the study population increased by 115.7 ng/dL after varicocelectomy (p<.0001). Significant improvements in testosterone levels were observed at all varicocele grades for men who underwent bilateral repair (p=.003) and in the combined group of men treated for a grade 2 or 3 unilateral left varicocele (p<.01). Although the change in serum testosterone level was not statistically significant among patients with moderate (grade 2) unilateral left varicoceles, an increase of 61.1 ng/dL was observed.

    For the same grade varicocele, increases in testosterone levels were greater among men who underwent bilateral versus unilateral varicocelectomy. A similar finding has been previously observed for improvements in semen quality after bilateral or unilateral varicocelectomy.

    Sperm count increases seen

    In the subset of 47 men who underwent semen analysis, the number of motile sperm significantly increased from 76.9 million at baseline to 128.1 million after varicocele repair (p=.0074).

    "What this study shows is that [men with] any varicocele that can actually be felt... regardless of whether it's a small one or a large one, will likely have a statistically significant increase in their testosterone levels after microsurgery," concluded senior author Marc Goldstein, MD, DSc (hon), director of the Weill Cornell Center for Male Reproductive Medicine and Microsurgery. The study was presented at the 2011 AUA annual meeting in Washington.

    The advantage to varicocele repair, according to Dr. Goldstein, is not only the immediate effect on testosterone levels and semen quality, but also in preventing the more rapid decline in testosterone with age that is observed in men with unrepaired varicoceles and potentially avoiding or delaying hormone deficiency that requires testosterone supplementation.

    "I would always advocate repairing it earlier rather than later," Dr. Goldstein said. "It is much easier to prevent both future infertility and future androgen deficiency than to treat it once it's already occurred. With current microsurgical techniques, repairing varicoceles is so safe now that, literally, the conservative treatment of big varicoceles in adolescents and teenagers is to repair—as that preserves testicular function—rather than wait until the damage has already occurred."

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