Varicocele and low testosterone

Varicocele repair raised testosterone by 80-100 ng/dL on average, per a review of existing studies

Journal: Fertility and Sterility | Published: 2026-03-13 | Type: Journal Article, Review | PMID: 41833628 Authors: Steele GL (Dept. of Urology, Massachusetts General Hospital); Tanrikut C (Dept. of Urology, Georgetown University School of Medicine; SGFertility) Funding/COI: No funding listed. Both authors report no conflicts of interest.

Summary

This is a narrative review, not a new study — the authors round up existing literature on varicocele's effect on testosterone rather than collecting new patient data. The headline figure: men with varicocele and low testosterone who underwent varicocelectomy saw total testosterone rise by roughly 80-100 ng/dL on average. The authors also flag that combining surgery with weight loss might get some men back to normal testosterone levels without needing hormone replacement.

Claims

• Varicoceles affect an estimated 15% of the general male population
• Men with varicocele and low testosterone show an average total testosterone increase of ~80-100 ng/dL after varicocelectomy
• Varicocelectomy combined with weight loss and other interventions may be sufficient to normalize testosterone without medication in some men
• The authors state that predictors of who benefits most (age, baseline testosterone, varicocele grade) are not yet well defined

Study Quality

This is a narrative review, meaning it synthesizes prior findings rather than generating primary data — no new patient cohort, no stated inclusion/exclusion criteria for which studies were pulled in, and no quantitative pooling (this is not a meta-analysis). The abstract does not report sample sizes, confidence intervals, or heterogeneity across the underlying studies it draws the 80-100 ng/dL figure from, which makes it impossible to judge how consistent or how noisy that number actually is.

The paper's own conclusion — that more research is needed to define predictors of response and the clinical significance of postoperative testosterone increases — is itself an admission that the evidence base is preliminary. A testosterone bump on paper doesn't automatically translate into a meaningful clinical outcome (symptoms, bone density, libido, etc.), and this review doesn't claim it does.

Red Flags

• No systematic methodology described — unclear how source studies were selected or screened
• No sample sizes, study designs, or quality assessment of the underlying literature reported in the abstract
• No pooled statistical analysis (not a meta-analysis despite reviewing quantitative outcomes)
• Clinical significance of testosterone gains is explicitly stated as unresolved by the authors themselves

Strengths

• Addresses a genuinely underexamined angle (testosterone, not just fertility) in varicocele research
• Both authors disclose no conflicts of interest and no industry funding
• Authors are transparent about the evidence gaps rather than overselling the findings
• Identifies concrete future research directions (age, baseline testosterone, varicocele grade as predictors)

Verdict

A useful pointer to an underdiscussed question, but this is a summary of other people's data, not new evidence — read it as a research agenda, not a result. The 80-100 ng/dL figure is worth knowing about, but without the underlying study details, there's no way to judge how solid that number really is.