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Smaller varicoceles may be too small to see or feel. Larger varicoceles may feel or look like a bag of worms or spaghetti. Fertility concerns are the top reason why people receive varicocele treatment.
A varicocele (VAIR-ick-oh-seal) is a common disorder that enlarges the veins in your scrotum. A healthcare provider can diagnose a varicocele and recommend the proper treatment. However, they’re a common cause of infertility. Prospective, long term, randomized trials are needed to help elucidate the benefit of varicocele repair on hypogonadal adolescent males. Consideration should be given to measuring T levels in adolescents with a varicocele. In 2011, Goldstein published a series of 110 infertile men with clinical varicoceles in whom pre- and post-operative T measurements were available.
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.
In those tested, all seminal parameters (concentration, motility and morphology) showed statistically significant improvement in the surgical vs. the observed group. In one series of 30 symptomatic boys average age 14.4, 77% demonstrated ipsilateral hypotrophy and the author recommended surgical correction (16). Varicoceles appear during adolescence as the testes enlarge and usually present as scrotal swelling and rarely pain (12-14). As controversial as treatment in adults has turned out to be, historically, this has been even more of a problem in teens. Fertility potential is not easily measured in the adult let alone the adolescent; as a result ipsilateral testicular hypotrophy/atrophy is commonly used as a surrogate indication.
Although, pre-operative T levels were not affected by the grade of the varicocele, the post-op increase in T was inversely related to the starting T. Sixty-six percent of the men had grade I-II varicoceles and counter-intuitively, the biggest changes in T were seen in the men with the lower grades of varicocele. A statistically significant increase in T levels was seen as early as one month from the repair, mean values increasing from 319 to 409 ng/dL. Interestingly, despite the the fact that the experimental procedure was unilateral, the enzymatic activity and intratesticular T levels were reduced in both testes (26). In the rat, ram, monkey, and man, the presence of a varicocele results in an increase in the intra-testicular temperature and hydrostatic pressure of both testes (22-25). In one study of teens with varicocele, T levels at presentation were on the low side (less than 300 ng/dL) but were unfortunately not measured post- operatively (20).
The recent adult literature suggests that hypogonadism may also be an indication for repair in adults and it seems that this should be studied in adolescents. Though T levels increased post-operatively in all, only three trials showed a statistically significant increase. Not all studies have shown the improvement seen in the previous two studies. When patients were stratified by pre-operative T of less than or more than 400 ng/dL, without stratification by age, men with the lower T had significant increases (mean 309 to 431 ng/dL, P29). - http://120.77.222.179:3000/willisykm35560
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