Asymptomatic postpubertal male with equally sized normal testicles with palpable left varicocele.

There are some studies showing that varicoceles may cause injury to the testicle outside of the typical symptoms of infertility and pain. In a study of 835 men, 325 of which had a palpable varicocele demonstrated that those with a varicocele had significantly lower testosterone levels that those without, 416 versus 469 ng dl −1. 9 This effect of testosterone does not seem to be affected by grade as shown in a study of 1111 men. 10 Repair in these individuals did seem to improve testosterone. About 29% of patients had >50% improvement in serum testosterone. Other studies have shown that mean improvements in total serum testosterone ranging from 90 to 178 ng dl −1 , which was not related to the grade of the varicocele. This has not been replicated by other groups and has not become a standard reason for repair of a varicocele. Treatment approach to the truly asymptomatic varicoceles in the postpubertal male remains an area of controversy. While there are indications to offer a ligation in patients who have accompanied seminal abnormalities or pain, in those who do not, the current recommendation is to observe them. In those who present with infertility, a normal partner evaluation and normal semen analysis, there is scant data to perform a varicocele ligation. There is emerging data about hypogonadism and varicoceles, but this has not made its way into the current recommendations so far. When confronted with such patients, we explain the controversies and gaps in knowledge while typically recommending against surgical intervention. Deterioration of semen parameters over time in men with untreated varicocele: evidence of progressive testicular damage. A follow‑up study of semen quality and fertility in men with varicocele testis and in control subjects. profiles of a large cohort of patients with different grades of varicocele. The effect of varicocelectomy on serum testosterone levels in infertile men with varicoceles. Varicoceles are a common finding in the general public. The incidence appears to increase later in life with a contemporary study finding an increase in incidence of 10% per decade of life. 1 While common in the general population, they are even more common among those presenting for a fertility evaluation, as high as 39% in some series and are often initially diagnosed during such examinations. 2 Others present without symptoms or fertility issues and are found incidentally on a physical exam by a general practitioner. Care for …