Can a varicocele cause an increase in Follicle-Stimulating Hormone (FSH) levels to 10, or is this a sign of an underlying condition?

Varicocele and FSH Elevation

Yes, a varicocele can cause an increase in FSH levels to around 10, but this elevation may also indicate underlying testicular dysfunction that should be further evaluated. 1, 2

Relationship Between Varicocele and Hormonal Changes

• Varicoceles are present in approximately 15% of the general male population but are found in 35-40% of men presenting with infertility, indicating a significant association between varicocele and fertility issues 1, 3
• Studies have shown that men with varicoceles can have hormonal alterations, including elevated FSH levels, which may reflect impaired testicular function 4
• In patients with bilateral grade 3 varicoceles, FSH levels have been found to be significantly increased compared to controls, particularly in those with infertility 2
• The pathophysiology involves multiple mechanisms affecting testicular function, including higher scrotal temperature, testicular hypoxia, reflux of toxic metabolites, and increased DNA damage 1

Clinical Significance of FSH Elevation

• An FSH level of around 10 IU/L in a patient with varicocele may indicate compromised spermatogenesis, as FSH rises in response to decreased inhibin B production from Sertoli cells 4
• Infertile men with varicoceles have been shown to have higher FSH levels (mean 7.8 ± 7.6 IU/L) compared to fertile men with varicoceles (3.5 ± 2.1 IU/L) 5
• The elevation in FSH is often accompanied by decreased testicular volume and reduced sperm parameters, suggesting underlying testicular dysfunction 5
• When evaluating elevated FSH in a patient with varicocele, it's essential to rule out other causes of FSH elevation before attributing it solely to the varicocele 1

Treatment Effects on Hormonal Parameters

• Varicocelectomy can lead to improvements in hormonal parameters, including FSH levels, particularly in patients with hypogonadism 6
• Hormonal improvements typically parallel the timeline for semen parameter improvements, taking approximately 3-6 months (two spermatogenic cycles) to show enhancement 7
• 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 regardless of hormonal status 7
• The European Association of Urology strongly recommends treating infertile men with clinical varicoceles and abnormal semen parameters to improve fertility rates 3

Clinical Approach to Elevated FSH in Varicocele Patients

• Perform a complete hormonal evaluation including testosterone, LH, FSH, and inhibin B to assess the extent of testicular dysfunction 4
• Evaluate semen parameters, as FSH elevation often correlates with abnormal spermatogenesis 5
• Consider testicular volume measurement, as decreased volume is associated with higher FSH levels and may indicate more severe testicular dysfunction 5
• For patients with FSH elevation and varicocele who have fertility concerns, varicocelectomy may be beneficial, especially if accompanied by abnormal semen parameters 8, 1

Potential Pitfalls and Considerations

• Not all varicoceles cause hormonal abnormalities; the presence and severity of hormonal changes depend on the grade of varicocele, duration, and individual susceptibility 4
• An FSH level of 10 IU/L could be within the upper limit of normal for some laboratories, so interpretation should be based on the specific reference range 4
• Subclinical (non-palpable) varicoceles should not be treated based solely on hormonal parameters, as treatment of these has not shown benefit 1, 3
• Other causes of FSH elevation should be considered, including primary testicular failure, Klinefelter syndrome, or other genetic causes of spermatogenic dysfunction 4