Does Follicle-Stimulating Hormone (FSH) decrease after varicocele repair?

FSH Decreases After Varicocele Repair

Yes, Follicle-Stimulating Hormone (FSH) levels typically decrease after varicocele repair, with studies showing an average reduction of 0.48 ng/dL following varicocelectomy. 1

Hormonal Changes After Varicocelectomy

• Meta-analysis data demonstrates that serum FSH levels are significantly higher before varicocele repair compared to post-operative measurements (95% confidence interval 0.19-0.77, P = 0.001) 1
• The decrease in FSH levels after varicocelectomy parallels improvements in semen parameters, which typically take 3-6 months (two spermatogenic cycles) to show enhancement 2
• This hormonal improvement is believed to be related to improved function of Leydig cells following varicocele repair 1
• Luteinizing hormone (LH) levels also decrease significantly after varicocelectomy, with an average reduction of 0.58 ng/dL 1

Factors Affecting FSH Response to Varicocelectomy

• The degree of FSH reduction may vary based on:
  • Varicocele grade - higher grades (more severe) tend to show greater hormonal improvements after repair 3
  • Pre-operative hormonal status - hypogonadal patients show more significant hormonal changes than eugonadal patients 4
  • Testicular volume - patients with larger testicular volumes tend to show better hormonal responses 5

Clinical Significance of FSH Changes

• FSH is a key marker of spermatogenic function, and its decrease after varicocelectomy indicates improved testicular function 6
• Pre-operative FSH levels can serve as a predictive indicator of successful varicocele repair outcomes 5
• Patients with serum FSH concentrations lower than 11.7 mIU/mL before surgery are more likely to achieve fertility after varicocele repair 5
• The peak/base ratio of FSH after luteinizing hormone-releasing hormone (LH-RH) stimulation significantly decreases after varicocelectomy (P = 0.007), further supporting improved testicular function 7

Timing of Hormonal Changes

• Hormonal improvements typically follow the same timeline as semen parameter improvements 2
• Most studies measure post-operative hormonal changes at 3 months after surgery 4
• The full extent of hormonal normalization may take up to 6 months 2

Clinical Implications

• The decrease in FSH after varicocelectomy supports the practice of treating clinical varicoceles in men with abnormal semen parameters 6
• Varicocele repair 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 2
• Monitoring FSH levels before and after varicocelectomy can provide valuable information about the success of the procedure in restoring testicular function 1

Caveats and Limitations

• While FSH typically decreases after varicocele repair, the magnitude of change varies among individuals 8
• Some studies show contradictory results regarding hormonal changes after varicocelectomy, highlighting the need for individualized assessment 8
• The relationship between clinical varicocele and impaired hormonal production is not entirely clear, and further research is needed 8
• A large-scale multicenter randomized controlled study would be beneficial to further confirm these findings 1