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 certain amount of evidence suggests that varicocele impairs testicular Leydig cells function with, in addition to its probable effects on semen alteration, a meaningful decrease in testosterone production (24, 25). Leydig cells are the testicular site of testosterone production and their possible damage by varicocele toxic environment, may lead to a decrease of testosterone and rise of LH serum levels, due to the lack of negative feedback to pituitary gonadotrophic cells (Figure 2). The impact of varicocele on semen production and fertility is known, but the relationship between clinical varicocele and impaired hormonal production is not clear; it has been hypothesized that the degree of varicocele may be inversely correlated with testosterone production (13, 14). Some studies confirmed a decrease of testosterone levels and higher FSH and LH levels that normalize after varicocelectomy, others found lower than normal levels of dihydrotestosterone due to decreased activity of epididymal 5-α-reductase. And for some men, varicoceles can affect sperm production and fertility .
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.
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.
Varicocele and subsequently testicular warming can cause decrease of testosterone synthesis by Leydig cells and impairment of germinal and Sertoli cells. Moreover, findings in experimental models suggest that short duration varicocele affects intratesticular testosterone firstly and subsequently plasmatic concentrations (50). Although numerous studies have shown testosterone reduction in infertile men with varicocele, there are also studies suggesting that it does not cause any changes. As the result of elevated scrotal temperature, ROS production and hypoxia, inhibition of enzymes involved in sexual steroid biosynthesis lead to decreased intratesticular testosterone production and conversion (49). In particular, Hudson et al. found a significant difference in free sexual steroid hormones (testosterone, estradiol) and Sex Hormone Binding Globulin (SHBG) pre- and post-varicocelectomy but only in men with excessive responses to Gonadotropins Releasing Hormon (GnRH). Concentration of AMH in the local spermatic vein was lower than in the peripheral blood, indicating that a poor blood supply in varicocele-bearing patient causes the degeneration of Sertoli cells function (41).
And the old days of only having big surgery with weeks of recovery are long gone. If you have a Grade 1 varicocele with no symptoms, your doctor might simply suggest watching it. Supportive care or minimally invasive treatment Usually no pain or very mild discomfort This matters because treatment often depends on how advanced your condition is . Others feel pain, heaviness, or notice a lump. The veins stretch and enlarge, like varicose veins in your legs .
Why are some men infertile with small varicoceles and others with huge varicoceles fertile? Indeed, the exact deleterious effects of varicocele on testicular function are unclear. What parent wants to risk future infertility of their son through inaction? Its impairment may underlie infertility, which if timely treated, could restore physiological wellbeing and improve the fertility rate. Lower testosterone levels inhibit the (androgen dependent) epididymal 5-α-reductase activity with a consequential reduced conversion to DHT (45). Heat inhibits C-17,20-lyase, the enzyme that converts 17-OH-progesterone to androstenedione and then testosterone, contributing to lowering androgen levels and rising 17-OH-progesterone levels (42). On the contrary, a progressive serum Inh-B levels reduction was observed from less severe to more severe testicular damage (39).
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.

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