Do men with moderate or large varicoceles (varicose veins in the scrotum) often have mildly elevated Follicle-Stimulating Hormone (FSH) levels?

Varicoceles and FSH Levels

Men with moderate or large varicoceles do not typically have mildly elevated FSH levels in the 9-12 IU/L range unless they have impaired spermatogenesis or testicular dysfunction. 1

Relationship Between Varicoceles and Hormonal Parameters

• FSH levels are typically normal (less than approximately 7.6 IU/L) in men with varicoceles who have normal testicular function and semen parameters 1
• Elevated FSH (>7.6 IU/L) is more commonly associated with spermatogenic failure or non-obstructive azoospermia rather than varicocele alone 1
• Infertile men with varicoceles have significantly higher FSH levels (7.8 ± 7.6 IU/L) compared to fertile men with varicoceles (3.5 ± 2.1 IU/L) or fertile men without varicoceles (3.5 ± 1.9 IU/L) 2
• The elevation in FSH is more likely related to the testicular dysfunction that may result from varicocele rather than the varicocele itself 3

Diagnostic Considerations

• 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 4
• FSH elevation in men with varicoceles is typically associated with:
  • Smaller testicular volumes 2
  • Lower sperm concentration and motility 2
  • Impaired spermatogenesis 4

Treatment Effects on Hormonal Parameters

• After varicocelectomy, there is often a decrease in FSH levels, particularly in men who had elevated levels before surgery 5, 6
• This decrease in FSH after varicocele repair suggests improvement in testicular function 6
• Varicocele repair has been shown to increase serum testosterone and inhibin B levels while decreasing FSH and LH levels 6, 7

Clinical Implications

• The European Association of Urology and American Urological Association recommend treating clinical varicoceles in infertile men with abnormal semen parameters 8, 4
• Microsurgical varicocelectomy is the recommended treatment approach for men with clinical varicoceles and abnormal semen parameters 8
• Treatment of subclinical (non-palpable) varicoceles is not recommended as it does not improve semen parameters or fertility rates 8, 4

Important Caveats

• FSH elevation in men with varicoceles should prompt evaluation for testicular dysfunction or spermatogenic failure 1
• The relationship between varicocele and hormonal alterations is complex and may vary between individuals 3
• Hormonal improvements after varicocelectomy typically take 3-6 months (two spermatogenic cycles) to become apparent 4
• Routine use of ultrasonography to identify non-palpable varicoceles is discouraged as treatment of these varicoceles does not improve outcomes 8, 4