Do varicoceles (varicose veins of the spermatic cord) raise Sex Hormone-Binding Globulin (SHBG) levels?

Varicoceles and Sex Hormone-Binding Globulin (SHBG) Levels

Varicoceles can raise Sex Hormone-Binding Globulin (SHBG) levels, and varicocele repair can significantly decrease elevated SHBG levels. 1

Relationship Between Varicoceles and Hormonal Parameters

• Varicoceles are present in approximately 15% of the normal male population, 25% of men with abnormal semen analysis, and 35-40% of men presenting with infertility, indicating a significant association between varicoceles and fertility issues 2, 3

• The pathophysiology of varicocele-induced testicular dysfunction involves multiple mechanisms including:

  • Higher scrotal temperature
  • Testicular hypoxia
  • Reflux of toxic metabolites
  • Increased DNA damage 3, 4

• Oligozoospermic men with varicoceles often demonstrate higher than normal levels of SHBG compared to healthy controls 1

Hormonal Alterations in Varicocele Patients

• Men with varicoceles and excessive gonadotropin responses to GnRH testing show:

  • Higher than normal SHBG levels
  • Lower than normal free testosterone
  • Higher than normal free estradiol 1

• These hormonal imbalances suggest that varicoceles can disrupt the hypothalamic-pituitary-gonadal axis, affecting both Leydig and Sertoli cell function 5

• The elevation in SHBG may be part of the compensatory mechanism in response to testicular dysfunction caused by varicocele 5, 1

Effects of Varicocele Repair on Hormonal Parameters

• After varicocelectomy, there is a significant decrease in SHBG levels, with studies showing a substantial reduction in SHBG levels post-surgery 3

• Surgical correction of varicocele leads to:

  • Decreased SHBG levels
  • Increased free androgen index
  • Improved semen parameters 6, 1

• The decrease in SHBG following varicocele repair typically parallels improvements in semen parameters, which usually take up to two spermatogenic cycles (approximately 3-6 months) to show enhancement 3, 4

Clinical Implications

• Hormonal evaluation, including SHBG measurement, may help identify patients who would benefit most from varicocele repair 5, 1

• Men with clinically palpable varicoceles and abnormal hormonal profiles (including elevated SHBG) are more likely to show improvements after varicocelectomy compared to those with normal hormonal parameters 1

• The European Association of Urology recommends treatment of clinical varicoceles in men with abnormal semen parameters to improve fertility outcomes 2, 4

• Treatment of subclinical (non-palpable) varicoceles is not recommended regardless of hormonal status 3, 4

Pitfalls and Considerations

• Not all men with varicoceles exhibit hormonal abnormalities, suggesting variability in individual susceptibility to varicocele-induced endocrine dysfunction 5, 1

• When evaluating elevated SHBG in patients with varicocele, it's essential to rule out other causes of SHBG elevation before attributing it solely to the varicocele 3

• The timing of hormonal assessment is important, as improvements typically take 3-6 months after varicocele repair 3, 4

• Microsurgical varicocelectomy is preferred to provide the best improvement in both hormonal and semen parameters 7, 8