Varicocele and FSH Levels
Yes, varicoceles can increase Follicle-Stimulating Hormone (FSH) levels, particularly in higher-grade varicoceles and those associated with testicular dysfunction. 1, 2, 3
Relationship Between Varicocele and FSH
- FSH levels are significantly higher in patients with grade 3 varicocele compared to those with grade 1-2 varicocele, indicating a correlation between varicocele severity and hormonal disruption 1
- The presence of testicular hypotrophy along with high-grade varicocele (grade 3) and severe spermatic vein reflux (grade 4) is associated with even higher FSH levels 1
- Bilateral varicoceles (grade 3) are associated with significant reduction in testicular function and significant increases in serum FSH levels 3
Mechanism of FSH Elevation
- Varicoceles impair testicular function through multiple mechanisms including:
- These mechanisms lead to testicular dysfunction, which triggers the hypothalamic-pituitary axis to increase FSH production in an attempt to stimulate spermatogenesis 2
Effect of Varicocele Treatment on FSH Levels
- After varicocelectomy, there is typically a significant decrease in FSH levels 2
- This hormonal improvement parallels improvements in semen parameters, which usually take approximately 3-6 months (two spermatogenic cycles) to show enhancement 6, 2
- A meta-analysis demonstrated that varicocele surgical repair can improve testicular function, increase serum testosterone and inhibin B levels, and decrease serum FSH and LH levels 2
Clinical Implications
- Elevated FSH in patients with varicocele is a marker of testicular dysfunction 1, 3
- The gonadotropin response to GnRH testing (particularly FSH) is considered a reliable predictive index of successful surgical outcome in terms of fertility 7
- Patients with an increased gonadotropin response (especially FSH) to GnRH are more likely to benefit from varicocele repair surgery 7
Important Considerations
- Treatment should be targeted to men with clinical varicoceles and abnormal semen parameters 5, 6
- Routine use of ultrasonography to identify non-palpable varicoceles is discouraged, as treatment of subclinical varicoceles is not associated with improvement in either semen parameters or fertility rates 8, 5
- The European Association of Urology strongly recommends surgery for varicocele when associated with a persistent small testis (size difference >2 mL or 20%), confirmed on two subsequent visits 6 months apart 4
- Varicocele repair has been shown to improve hormonal parameters, including decreasing FSH levels, which may contribute to improved fertility outcomes 9, 2