Varicocele as a risk factor for androgen deficiency and effect of repair

Study Type – Therapy (case control) Level of Evidence 2b

OBJECTIVE

? To determine whether men with varicoceles have lower testosterone levels than those without and to ascertain if testosterone levels increase after varicocelectomy.

PATIENTS AND METHODS

? We measured preoperative testosterone levels in 325 men with palpable varicoceles and in 510 men with vasectomy reversal without varicoceles who served as a comparison group. ? The testosterone levels between groups were compared by age. Of the men with varicoceles, 200 had data on both pre‐ and postoperative testosterone levels, which were compared to assess postoperative changes.

RESULTS

? Men with varicocele had significantly lower testosterone levels than the comparison group, with mean (sd ) levels of 416 (156) vs 469 (192) ng/dL (P < 0.001). This difference persisted when analysed by age. ? The testosterone levels significantly increased after repair from 358 (126) to 454 (168) ng/dL (P < 0.001). ? Of the 70% of patients with postoperative improvement in testosterone levels, the mean (sd ) increase in testosterone was 178 (142) ng/dL. The percentage change in testosterone levels was: 30% had no increase, 41% increased by ≤50%, 19% increased between by 51–100%, and 10% increased by >100%. ? There was no association between change in testosterone level and age, laterality of varicocele, or varicocele grade.

CONCLUSIONS

? Men with varicoceles had significantly lower testosterone levels than the comparison group of men with vasectomy reversal. ? Microsurgical varicocele ligation resulted in a significant increase in serum testosterone levels in more than two‐thirds of men. ? These findings suggest that varicocele is a significant risk factor for androgen deficiency and that repair may increase testosterone levels in men with varicocele and low testosterone levels.