FSH Decrease After Severe Varicocele Repair
In severe varicocele cases, FSH levels decrease by approximately 1.43 mIU/mL after varicocelectomy. 1
Hormonal Changes Following Varicocele Repair
- FSH levels significantly decrease after varicocelectomy compared to pre-treatment values, with a mean difference of 1.43 mIU/mL (95% CI: -1.82 to -1.04; p<0.00001) according to the most recent and comprehensive meta-analysis on this topic 1
- The decrease in FSH levels ranges from 0.1 to 4.8 mIU/mL across different studies, with an average decrease of 0.48 mIU/mL reported in another meta-analysis 2
- FSH levels also decrease significantly when compared to patients with unrepaired varicoceles (mean difference -2.35 mIU/mL, 95% CI: -4.06 to -0.65; p=0.007) 1
- These hormonal improvements typically take up to two spermatogenic cycles (approximately 3-6 months) to manifest after varicocele repair 3
Clinical Significance of FSH Changes
- FSH levels serve as an independent predictor of successful varicocele repair outcomes, with lower preoperative FSH levels (<11.7 mIU/mL) associated with better fertility outcomes 4
- The decrease in FSH levels following varicocelectomy reflects improved testicular function, particularly of Sertoli cells 2, 5
- Despite the decrease after repair, FSH levels in patients with treated varicoceles remain significantly higher than those in healthy controls without varicocele (mean difference 2.71 mIU/mL, 95% CI: 1.12-4.31; p=0.0009) 1
Other Hormonal Changes After Varicocelectomy
- Luteinizing hormone (LH) levels also decrease after varicocele repair, with a mean difference of 0.37 IU/L (95% CI: -0.74-0.01; p=0.06) compared to pre-treatment values 1
- The average decrease in LH levels ranges from 0.2 to 2.1 mIU/mL, with a mean decrease of 0.58 mIU/mL 2
- Testosterone levels significantly increase after varicocelectomy, particularly in hypogonadal patients (from 215.22±83.31 ng/dL to 326.95±35.125 ng/dL, p<0.0001) 6
Clinical Implications and Treatment Recommendations
- Varicocele treatment should be targeted to men with clinical varicoceles and abnormal semen parameters 3, 7
- Treatment of subclinical (non-palpable) varicoceles is not recommended regardless of hormonal status 3, 7
- Hormonal improvements after varicocelectomy parallel improvements in semen parameters, which typically take 3-6 months to show improvement 3
- Patients with testicular volume of at least 30 mL or serum FSH concentrations lower than 11.7 mIU/mL are more likely to achieve fertility after varicocele repair 4
Pitfalls and Caveats
- The relationship between clinical varicocele and hormonal alterations remains incompletely understood, with some contradictory results in the literature 5
- Routine use of ultrasonography to identify non-palpable varicoceles is discouraged, as treatment of subclinical varicoceles does not improve fertility outcomes 7
- The decrease in FSH levels may vary significantly between individuals, and the range reported in studies is quite wide (0.1 to 4.8 mIU/mL) 2
- Hormonal evaluation may be useful for establishing the duration of varicocele and for identifying patients who would benefit most from surgical correction 5