Does repairing a varicocele cause Sex Hormone-Binding Globulin (SHBG) to decrease?

Effect of Varicocele Repair on Sex Hormone-Binding Globulin (SHBG)

There is no direct evidence that varicocele repair causes a decrease in Sex Hormone-Binding Globulin (SHBG) levels. While varicocele repair has been shown to affect various hormonal parameters, the available evidence does not specifically address SHBG changes after varicocelectomy.

Hormonal Changes After Varicocele Repair

• Varicocele repair has been demonstrated to increase testosterone levels, particularly in hypogonadal men (testosterone <280 ng/dL), with significant improvements observed after surgery 1, 2
• Post-varicocelectomy, there are documented decreases in luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels, likely due to the improvement in testosterone production 1, 3
• In a meta-analysis of 452 patients, varicocele surgical repair was shown to improve testicular function by increasing serum testosterone and inhibin B levels while decreasing serum FSH and LH levels 3

Varicocele Prevalence and Impact on Male Fertility

• Varicocele is present in approximately 15% of the normal male population, but this percentage increases to 25% in men with abnormal semen analysis and 35-40% in men presenting with infertility 4, 5
• The exact mechanism linking varicocele to reduced fertility remains incompletely understood but includes higher scrotal temperature, testicular hypoxia, and reflux of toxic metabolites that can cause testicular dysfunction 5

Treatment Recommendations

• Treatment of clinically palpable varicocele may be offered to the male partner of an infertile couple when there is evidence of abnormal semen parameters and minimal/no identified female factor 4
• Varicocele treatment should be targeted to men with clinical varicoceles and abnormal semen parameters, as treatment of men with normal semen analysis or subclinical varicoceles is not recommended 5, 6
• Improvements in semen parameters typically take up to two spermatogenic cycles (approximately 3-6 months) after varicocelectomy 5

Hormonal Profile in Varicocele Patients

• Men with varicoceles have been shown to have significantly lower testosterone levels than men without varicoceles (416 ng/dL vs. 469 ng/dL) 7
• After microsurgical varicocele repair, more than two-thirds of men experience a significant increase in serum testosterone levels 7
• Some studies have reported lower circulating Anti-Müllerian Hormone and Inhibin-B levels in varicocele patients, indicating decreased Sertoli cell function 8

Clinical Implications

• For men with hypogonadism and varicocele, varicocele repair offers an advantage over testosterone replacement therapy by preserving fertility potential 2
• Microsurgical varicocele repair appears to provide the best hormonal improvement outcomes 2
• While varicocele repair has clear effects on testosterone, LH, and FSH levels, there is no specific evidence regarding its effect on SHBG levels 1, 3, 8

Pitfalls and Caveats

• Routine use of ultrasonography to identify non-palpable varicoceles is discouraged, as treatment of subclinical varicoceles does not improve fertility outcomes 5
• The relationship between varicocele and hormonal alterations remains incompletely understood, with some contradictory findings in the literature 8
• Further multicentre, randomized controlled studies are needed to better clarify the complete hormonal profile changes in patients with varicocele before and after repair 8