The association between varicocele and male infertility is well established. Modern artery and lymphatic-sparing techniques of varicocele repair have been shown to significantly enhance semen quality and increase pregnancy rates. However, the effect of varicocele on testosterone production is less well defined and the possible association with androgen deficiency is controversial. Data regarding the effects of varicocelectomy on serum testosterone levels are limited and conflicting.
Few studies in the past 18 months have assessed the impact of varicocele repair on serum testosterone levels. The limited data available are culled from a diverse patient population with the goal of evaluating other primary outcome parameters and thus provide a challenge for drawing definitive conclusions. One of the more interesting recent studies uses a rat model of varicocele and varicocelectomy to assess changes in intratesticular testosterone levels.
Although the impact of varicocele on testosterone production is not well understood and the utility of varicocelectomy to prevent or reduce deterioration in Leydig cell function remains unproven, recent data suggest an adverse effect of varicocele and possible benefit of repair. Further human clinical studies are warranted to better define these relationships.
aDepartment of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
bDepartment of Urology and Institute for Reproductive Medicine, Weill Cornell Medical College of Cornell University, USA
cThe Population Council, Center for Biomedical Research, Rockefeller University, New York, New York, USA
Correspondence to Cigdem Tanrikut, MD, MGH Fertility Center, 55 Fruit Street, YAW 10A, Boston, MA 02114, USA Tel: +1 617.643.0044; fax: +1 617 724 8882; e-mail: firstname.lastname@example.org