Endocrine Testing and the Association Between Varicocele and Hypogonadism

Abstract

Varicocele is a common condition resulting from an abnormal dilation of the pampiniform vein plexus within the spermatic cord. The exact pathophysiologic impact of varicocele on the testicular environment continues to be explored. The progressive testicular injury caused by varicocele may involve increased intratesticular temperature, increased oxidative stress, and the reflux of gonadotoxic renal and adrenal metabolites. There is increasing evidence that, in addition to spermatogenesis, production of testosterone by Leydig cells and the delivery of this hormone to the systemic blood stream may also be impacted by varicocele. While surgical repair of varicocele is most commonly performed for male infertility and leads to improvement in semen parameters in most men, new research indicates the correction of varicocele may also improve the function of Leydig cells, and, therefore, testosterone levels in hypogonadal men. Hypogonadism has been associated with erectile dysfunction, decreased sex drive, loss of muscle mass, and loss of bone composition. Currently, treatment of primary hypogonadism includes testosterone replacement therapy or use of GnRH agonist. Varicocele repair could treat hypogonadism by improving the function of Leydig cells while maintaining the homeostasis of the endocrine feedback system. Pre- and postsurgical endocrine testing should be incorporated in the evaluation of men in whom surgical correction of varicocele is considered. With careful selection and counseling, microsurgical varicocele repair may be offered to men with clinical varicocele and hypogonadism to improve their total serum testosterone.