Many studies demonstrated changes of serum FSH and LH in men with varicocele, but the reasons are not clear. Although the consequences of varicocele and its resolution have been described for decades, only few studies have been conducted in this field, often retrospective, and therefore with limited value even because with contradictory results (26–28). Sertoli cells are also the principal site of production of Inhibin-B (Inh-B) that acts as a circulating feedback modulator of FSH secretion by the pituitary gland. Varicocele increase internal scrotal temperature and can cause decrease of testosterone synthesis by Leydig cells, reduction of Sertoli cells function and germinal cells damage. In Leydig cells, Luteinizing Hormone (LH) stimulates steroidogenesis by triggering the cascade of events at mitochondrial level leading from cholesterol to testosterone. Varicocele treatment depends on the severity of your varicocele. There isn’t enough research to definitively say that varicoceles cause erectile dysfunction (ED), but there may be a link. Healthcare providers believe that many varicoceles are present at birth (congenital). Some think that a faulty "switch" (valve) inside certain veins in the spermatic cord may cause them. Healthcare providers and medical experts aren’t sure what causes varicoceles to develop. After confirming the presence of a varicocele, your provider will grade its severity. They’ll feel your scrotum for enlarged veins as you’re holding your breath and straining. A healthcare provider can diagnose a varicocele. In some cases, the varicocele can prevent your testicle from growing properly. People often notice a varicocele during their teenage years. When a valve doesn’t work the way it should, blood may build up inside the veins in your testicles. Your healthcare provider may not recommend treatment if you have a small varicocele that doesn’t bother you or cause fertility issues. Some studies show that people who receive varicocele treatment may still sometimes fail to achieve an erection, but not as often. In some people, a varicocele may cause infertility. The surgical treatment of the adolescent varicocele is controversial and debated. Six of 18 men (33%) with pre-operative subnormal T levels decreased after the repair (28). Yet not all men with subnormal T levels improved after repair. Many studies demonstrated an inverse correlation between circulating Inh-B and FSH in fertile and infertile men; this would explain the rise of FSH levels in men with varicocele. The aim of the present review was to elucidate the hormonal features of patients with varicocele. Among men evaluated for infertility varicocele is still the most frequent finding, identified in 35% of men with primary sterility and 70–80% of men with secondary sterility (13). In accordance, ongoing EAU Guidelines on Male Infertility support specific indications for varicocele surgical correction both in adults and adolescents. However, a recent multicenter worldwide study encouraged by the European Academy of Andrology (3, 4) reported in men without any health or fertility problems a high incidence of varicocele (~37%) similar to men with primary infertility (5–7). It affects around 15% of male population but it is more frequently identified in patients searching medical care for infertility (1, 2). The finding of higher basal 17-OH-progesterone concentrations in patients with varicocele was explained by some authors with a testicular C-17,20-lyase deficiency. Many people with varicoceles have no symptoms at all. If you have a higher-grade varicocele and don’t get treatment, it can permanently damage your testicles. Most people make a full recovery after a varicocelectomy within six weeks.
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