Varicoceles linked with low testosterone, but levels increase after surgery
MedWire News: Testosterone levels are significantly lower in men with varicoceles than in men without the venous condition, research shows.
Androgen deficiency, however, appears reversible, as investigators showed that microsurgical ligation of the varicocele resulted in a significant increase in testosterone levels.
"At the very least, repair is likely to restore men to the normal slope of age-related decline in testosterone," write Cigden Tanrikut (Cornell University, New York, USA) and colleagues in the BJU International.
Varicocele, an abnormal dilation of veins draining the testes, is known to have a negative effect on spermatogenesis. The condition is the most common cause of male infertility.
In the present study, the investigators measured pre-operative testosterone levels in 325 men with palpable varicoceles and 510 men with vasectomy reversal without varicoceles who served as controls.
The mean baseline testosterone level in the varicocele patients was 416 ng/dl, a level that was significantly lower than the 469 ng/dl observed in the control arm.
The difference between the two groups persisted when stratified by age.
After repair, testosterone levels increased significantly, from 358 ng/dl to 454 ng/dl.
There was a significant increase in testosterone levels in 70% of patients treated. Among the patients in whom an increase was noted, testosterone levels increased by 178 ng/dl.
Similarly, among the patients who had an improvement in testosterone levels, 41% had an increase of 50% or less, whereas 19% had an improvement ranging from 51% to 100%. One in 10 patients had an increase in testosterone levels exceeding 100%.
Varicoceles are observed in approximately 15% of the general population, and in about 33% of men who present for evaluation of primary infertility.
To treat varicoceles, subinguinal microsurgical varicocelectomy is the technique with the lowest reported rates of failure and morbidity.
"The present findings also indicate microsurgical varicocelectomy as a means to improve serum testosterone levels," conclude Tanrikut and colleagues.
Testosterone levels decrease as men age, but studies have shown that androgen insufficiency predisposes men to a host of conditions, including sexual dysfunction, bone mineral density loss, and reduced strength, among others.
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