InfertilityVaricocelectomy Is Associated With Increases in Serum Testosterone Independent of Clinical Grade
Section snippets
Patients and Evaluation
After obtaining institutional review board approval, we performed a retrospective review of patients who had undergone subinguinal microsurgical varicocelectomy by a single surgeon from January 1996 to January 2010. Patients were referred for male infertility, testicular pain, and/or low testosterone. In our practice, the indications for varicocelectomy include clinically palpable varicocele with semen parameter abnormalities, clinically palpable varicocele associated with pain, clinically
Baseline Characteristics
A total of 78 men were included in the final analysis. Their average age was 36.4 ± 1.0 years. Of these 78 men, 59 had undergone bilateral varicocelectomy and 19 unilateral varicocelectomy. When divided by bilateral versus unilateral varicocelectomy, no differences were found in the endocrine parameters or sperm counts (Table 1). We classified the 59 patients who had undergone bilateral varicocelectomy by the largest varicocele present on either side: 35 (59%) had a grade 3 varicocele, 17 (29%)
Comment
In the present study, varicocelectomy was associated with improvement in the serum testosterone level in >80% of patients, with a mean increase of approximately 140 ng/dL in those with improvement. Although the correction of a greater clinical grade of varicoceles has been shown to result in greater improvement in semen parameters, the clinical grade does not seem to predict improvement in the serum testosterone level.
It is notable that our practice has not offered varicocelectomy to those
Conclusion
The results of our study have shown that subinguinal microsurgical varicocelectomy is associated with significant increases in serum testosterone levels, regardless of the palpable varicocele grade. Our results suggest that repair of even small varicoceles can increase serum testosterone levels. We have demonstrated an improvement in serum testosterone levels in a younger population; however, additional studies are needed of older men with symptomatic low testosterone levels.
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Financial Disclosure: Marc Goldstein is a consultant to Theralogix; the remaining authors declare that they have no relevant financial interests.