Should a Varicocele Be Repaired in Non-infertile Patients with Hypogonadism?

  • Taha Abo-Almagd Abdel-Meguid HamodaEmail author


Varicocele is a common condition that has been traditionally linked to impaired spermatogenesis and infertility. More recently, however, there is a growing evidence that varicocele may also jeopardize Leydig cell function with consequential impairment of testosterone biosynthesis and hypogonadism, which could be reversed with varicocelectomy. The pathophysiology of varicocele-induced Leydig cell ultrastructural and functional alterations and impaired steroidogenesis is still illusive, and several mechanisms have been proposed. While testicular hyperthermia theory prevails, the pathophysiology is more likely multifactorial.

Several contemporary studies confirmed improvements of androgen levels after repair of varicocele which were found to be inversely correlating to baseline serum testosterone levels, with higher response in baseline hypogonadal men compared to eugonadals.

Very few studies have examined the association between varicocele and hypogonadism symptoms, such as erectile dysfunction (ED), hypoactive sexual drive, as well as premature ejaculation (PE), to report improvements of these sexual functions after varicocelectomy. However, these studies have several flaws and the hypothesis of improvement of sexual symptoms after varicocelectomy is still lacking good evidence.

The majority of studies supporting varicocele-hypogonadism relationship have primarily focused on infertile men, while evidence addressing varicocele-hypogonadism linkage among fertile men is still lacking. Thus, proposing varicocelectomy as a treatment of biochemical or symptomatic hypogonadism among fertile men should not be considered as a standard of care in the routine practice and should be only contemplated on an experimental basis.


Androgen Hypogonadism Infertility Leydig cell Testicle Testosterone Varicocele Varicocelectomy Sexual dysfunction Spermatogenesis 


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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Urology, Faculty of MedicineKing Abdulaziz UniversityJeddahSaudi Arabia
  2. 2.Department of Urology, Faculty of MedicineMinia UniversityEl-MiniaEgypt

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