Volume 29, Issue 160, June 2025

The Impact of Varicocelectomy on Hormonal Function in Hypogonadal and Eugonadal Men: Literature Review

Piotr Gaworek^1♦, Adam Torbicki², Krzysztof Pawlikowski³, Michał Korpalski⁴, Maria Pawluczyk⁵, Mateusz Marciniak⁶, Marek Żygłowicz⁷, Dominik Augustyn⁸, Alicja Trybuła⁹

¹Międzyleski Specialist Hospital in Warsaw, Bursztynowa 2 Street, 04- 749 Warsaw, Poland
²Nicolaus Copernicus Hospital, COPERNICUS Medical Entity limited liability company under Polish law, Nowe Ogrody 1/6 Street, 80-803 Gdańsk, Poland
³University Clinical Center of the Medical University of Warsaw, Banacha 1A, 02-097 Warsaw, Poland
⁴Dr. Tytus Chałubiński Radom Specialist Hospital, Adolfa Tochtermana 1 Street, 26-610 Radom, Poland
⁵District Hospital in Sochaczew, Batalionów Chłopskich 3/7 Street, 96- 500 Sochaczew, Poland
⁶Mikołaj Kopernik Provincial Multi-Specialist Center of Oncology and Traumatology Pabianicka 62, 93-513 Łódź; Poland
⁷Ludwik Rydygier Specialist Hospital, Złota Jesień 1 Street, 31-826 Kraków, Poland
⁸Ludwik Rydygier Specialist Hospital, Złota Jesień 1 Street, 31-826 Kraków, Poland
⁹Kazimierz Pułaski University of Technology and Humanities in Radom: Radom, Mazovia, PL Jacka Malczewskiego 29, 26-600 Radom, Poland

^♦Corresponding author
Piotr Gaworek, Międzyleski Specialist Hospital in Warsaw, Bursztynowa 2 Street, 04-749 Warsaw, Poland

ABSTRACT

Introduction: Varicocele is a common condition affecting up to 15% of men. It is associated with impaired testicular function due to venous reflux and oxidative stress. While its role in male infertility is well established, the extent to which it impacts hormonal function, particularly testosterone production, is still being debated. The purpose of this review was to evaluate the hormonal outcomes of varicocelectomy, with a particular focus on differences between hypogonadal and eugonadal men. To determine whether both groups benefit from the surgery. Materials and Methods: A literature review was conducted using the PubMed and Google Scholar databases to identify published studies from 2014 to 2024. Metaanalyses, systematic reviews, and original studies reporting hormonal parameters before and after varicocelectomy were included in the analysis. Studies were selected based on inclusion and exclusion criteria, and hypogonadism was defined as total testosterone <300 ng/dL, according to AUA guidelines. Results: Twelve studies (four meta-analyses and eight original articles) were included. Most metaanalyses and prospective studies showed a significant increase in serum testosterone levels in hypogonadal men after varicocelectomy. In contrast, eugonadal men generally showed no significant hormonal changes. Small decreases in LH and FSH levels were also observed postoperatively, suggesting improved regulation of the hypothalamic-pituitary-testicular axis. Conclusion: Varicocelectomy appears to provide endocrine benefits in hypogonadal men with clinically significant varicoceles and can be considered a therapeutic alternative to testosterone replacement therapy. In eugonadal men, routine surgery is not justified. Future research should focus on risk stratification and surveillance strategies to identify patients with varicocele at risk for progressive Leydig cell dysfunction.

Keywords: varicocele, varicocelectomy, testosterone, hypogonadism, Leydig cell function

Medical Science, 2025, 29, e94ms3635

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DOI: https://doi.org/10.54905/disssi.v29i160.e94ms3635

Published: 29 June 2025