Varicocele and Low Testosterone: Does Varicocele Repair Raise Testosterone Levels?

Varicocele and low testosterone are linked: a 2024 meta-analysis found men with a varicocele had 3.27 times the odds of hypogonadism. In men whose testosterone was already low, repair raised it by 113.87 ng/dL on average across 18 studies. Men with normal levels saw little change.

Varicocele and low testosterone show up together more often than chance would predict. A varicocele is a cluster of enlarged veins in the scrotum, usually on the left side, and it affects roughly 15% of men. A 2024 meta-analysis by Gonzalez-Daza and colleagues found that men with a varicocele had 3.27 times the odds of hypogonadism, the medical term for low testosterone with symptoms. The bigger question for most men is whether repairing the vein brings testosterone back up.

The short answer from the research is yes, for men whose levels are already low, and much less for men whose levels are normal. This guide covers how a varicocele affects the testicle, what the studies in men over 50 show, how much testosterone rises after repair, which surgical approach has the fewest complications, and how repair compares with testosterone replacement therapy. Every figure comes from peer-reviewed studies opened and checked for this article.

A varicocele can contribute to low testosterone, according to the pooled observational data. Gonzalez-Daza and colleagues reviewed ten studies and pooled six of them in Actas Urologicas Espanolas in 2024. Most reported a correlation between having a varicocele and lower testosterone, and the meta-analysis found an odds ratio of 3.27 for hypogonadism. The confidence interval was wide, from 1.23 to 8.68, and the authors said more studies are needed.

Testosterone is made by Leydig cells, which sit between the sperm-producing tubules inside each testicle. A varicocele is thought to stress these cells by letting blood pool and warm the testicle. A 2017 review by Clavijo and colleagues in Fertility and Sterility notes that varicocele affects up to 15% of men, yet few of them ever have fertility problems. The same logic applies to hormones: plenty of men with a varicocele have normal testosterone, so the vein is a risk factor rather than a guarantee.

Varicoceles appear to be more common in older men than in young adults. Canales and colleagues examined 354 men in a prostate cancer screening program, with a mean age of 60.7, and published the results in Urology in 2005. They found a varicocele in 42% of the men, compared with the approximately 15% usually reported in adolescents and young adults. The authors noted the jump could reflect a true increase with age or more careful examination.

In the Canales study, bilateral varicoceles were found in 19.8% of men, left-sided only in 22.0% and right-sided only in 1.1%. Men with bilateral varicoceles had smaller and softer testicles. Lower testosterone in that group tracked with older age and soft testicles rather than with the varicocele itself, which is an important caution against blaming every low result on the vein.

In the largest study of older men, testosterone was markedly lower in men with a varicocele. Kim, Teloken and Mulhall at Memorial Sloan Kettering reviewed early-morning testosterone in 776 men aged 50 and older, with a mean age of 66, and published the results in Urology in 2025. The 18% who had a varicocele on examination averaged 336 ng/dL of total testosterone, against 472 ng/dL in men without one.

Both sides mattered in the Memorial Sloan Kettering data. Men with bilateral varicoceles averaged 297 ng/dL, compared with 372 ng/dL for a single varicocele. Testosterone below 300 ng/dL was found in 11% of men with a unilateral varicocele and 24% with bilateral ones. Grade III varicoceles, the largest kind that can be seen through the skin, carried the strongest link, while grade I showed no association with low testosterone.

A Turkish cross-sectional study by Besiroglu and colleagues in The Aging Male in 2019 pointed the same way in men over 40. Smaller testicles were found in 20.60% of men with grade 1 varicoceles, 79.80% with grade 2 and 88.70% with grade 3. The authors concluded that varicocele was associated with smaller, softer testicles and lower testosterone, especially in older men with bilateral and high-grade varicoceles.

Varicocele repair does increase testosterone in men whose levels are low before surgery. The newest meta-analysis, by Aboukhshaba and colleagues in the World Journal of Men's Health in 2026, pooled 18 studies with 1,225 hypogonadal men. Repair, known as varicocelectomy, raised serum testosterone by 113.87 ng/dL on average, and the gain held both before and after the 6-month mark.

Sexual function improved alongside testosterone in the Aboukhshaba meta-analysis. Erectile function scores rose by 3.25 points, and LH, the pituitary hormone that tells the testicles to make testosterone, fell slightly by 0.28 mIU/mL, which suggests the testicles were responding better. FSH did not change. Most participants were in their late 20s to mid-40s, and most of the studies were observational rather than randomized.

Baseline testosterone is what separates men who gain from men who do not. A 2017 meta-analysis by Chen and colleagues in Andrologia included 712 patients from 8 studies. Across all men, testosterone rose by only 34.3 ng/dL. In the hypogonadal subgroup it rose by 123 ng/dL, and compared with untreated controls, hypogonadal men gained 105.65 ng/dL. In men with normal testosterone, the difference against controls was not significant.

A 2026 review by Steele and Tanrikut in Fertility and Sterility put the typical gain at approximately 80 to 100 ng/dL for men with a varicocele and low testosterone. The authors suggested that repair combined with weight loss may lift testosterone enough to avoid medication for some men, and called for more research on who benefits most and whether the rise changes how men feel.

About half of hypogonadal men reached the normal range after repair in the largest single-center series. Saylam, Cayan and Akbay followed 202 infertile men with testosterone below 3.5 ng/mL, published in The Aging Male in 2020. Average testosterone rose from 2.55 to 3.72 ng/mL after microsurgical repair, and 105 men (52%) ended at 3.5 ng/mL or higher. Of the men who reported low libido before surgery, 86.6% reported increased libido afterward.

Varicocele repair still raised testosterone in men aged 40 and older in the main study that compared age groups. Hsiao and colleagues reviewed 272 men treated by a single surgeon with microsurgical subinguinal repair, published in the Journal of Urology in 2011. Among men with baseline testosterone of 400 ng/dL or less, the mean gain was 110 ng/dL in 21 men aged 40 or older, 133 ng/dL in 30 men aged 30 to 39 and 136 ng/dL in 21 men under 30.

The Saylam series found something similar: older age was the only factor that predicted reaching normal testosterone after surgery. Both studies are retrospective and the age subgroups are small, so they show that older men can respond, not that every older man will. Men over 40 with a long-standing varicocele and soft, shrunken testicles may have less tissue left to recover.

Microsurgical repair through a small groin incision has the best balance of low recurrence and few complications in the network meta-analyses. Wang and colleagues compared 10 treatment methods across 35 studies in the Asian Journal of Andrology in 2015. Against open retroperitoneal surgery, microsurgical subinguinal and inguinal repair had odds ratios of 0.05 and 0.06 for recurrence and 0.09 and 0.07 for overall complications.

A 2025 network meta-analysis by Lu and colleagues, covering 13 randomized trials and 24 cohort studies across 9 methods, reached the same conclusion. Microsurgical subinguinal varicocelectomy ranked highest for preventing recurrence, at 91.6% on the ranking scale, and was judged the most effective option overall. Surgeon experience and the patient's preferences still shape the choice.

Embolization, where a radiologist blocks the vein from inside through a catheter, trades recurrence for fewer complications. Chen and colleagues pooled 30 studies in the World Journal of Urology in 2025. Sclero-embolization carried a higher recurrence rate than high surgical ligation (odds ratio 1.37) but fewer overall complications (0.65) and much less hydrocele, a fluid collection around the testicle (0.19).

Varicocele repair and testosterone replacement therapy are both reasonable options for men with low testosterone and a clinical varicocele, and they work in opposite ways. TRT supplies testosterone from outside and suppresses the body's own production and sperm output. Repair aims to help the testicles make more of their own testosterone. In a 2018 article in European Urology Focus, Bernie and Goldstein argued that a one-time low-risk microsurgery may spare some older men from lifelong therapy.

The trade-off is predictability. Repair raises testosterone by roughly 100 ng/dL on average, which is enough to bring some men into the normal range and not enough for others. TRT reliably lifts levels but requires ongoing injections or gels, blood monitoring and attention to hematocrit. For men who still want children, preserving the body's own production matters, and our guides to enclomiphene as a fertility-preserving alternative and to TRT delivery methods explain the other options.

This article is for educational purposes only and is not medical advice. It does not diagnose, treat, cure or prevent any disease. See a doctor promptly for a new lump in the scrotum, a varicocele that appears suddenly on the right side, or one that does not empty when lying down, since these need examination.

• Aboukhshaba A et al. Effect of Varicocelectomy on Testosterone Parameters in Hypogonadism: A Systematic Review and Meta-Analysis. World Journal of Men's Health, 2026. https://doi.org/10.5534/wjmh.250255
• Chen X et al. Efficacy of varicocelectomy in the treatment of hypogonadism in subfertile males with clinical varicocele: A meta-analysis. Andrologia, 2017. https://doi.org/10.1111/and.12778
• Gonzalez-Daza SJ et al. Association between varicocele and hypogonadism, or erectile dysfunction: A systematic review and meta-analysis. Actas Urologicas Espanolas, 2024. https://doi.org/10.1016/j.acuroe.2024.06.006
• Kim DJ, Teloken PE, Mulhall JP. Exploring the Association Between Varicocele and Testosterone Deficiency in Men Over 50 Years of Age. Urology, 2025. https://doi.org/10.1016/j.urology.2025.06.029
• Canales BK et al. Prevalence and effect of varicoceles in an elderly population. Urology, 2005. https://doi.org/10.1016/j.urology.2005.03.062
• Besiroglu H et al. The prevalence and severity of varicocele in adult population over the age of forty years old: a cross-sectional study. The Aging Male, 2019. https://doi.org/10.1080/13685538.2018.1465913
• Clavijo RI et al. Varicoceles: prevalence and pathogenesis in adult men. Fertility and Sterility, 2017. https://doi.org/10.1016/j.fertnstert.2017.06.036
• Steele GL, Tanrikut C. Varicocele and low testosterone. Fertility and Sterility, 2026. https://doi.org/10.1016/j.fertnstert.2026.03.011
• Hsiao W et al. Older age is associated with similar improvements in semen parameters and testosterone after subinguinal microsurgical varicocelectomy. Journal of Urology, 2011. https://doi.org/10.1016/j.juro.2010.09.114
• Saylam B, Cayan S, Akbay E. Effect of microsurgical varicocele repair on sexual functions and testosterone in hypogonadal infertile men with varicocele. The Aging Male, 2020. https://doi.org/10.1080/13685538.2020.1769589
• Bernie HL, Goldstein M. Varicocele Repair Versus Testosterone Therapy for Older Hypogonadal Men with Clinical Varicocele and Low Testosterone. European Urology Focus, 2018. https://doi.org/10.1016/j.euf.2018.09.017
• Wang J et al. Inguinal and subinguinal micro-varicocelectomy, the optimal surgical management of varicocele: a meta-analysis. Asian Journal of Andrology, 2015. https://doi.org/10.4103/1008-682X.136443
• Lu LJ et al. Surgical approaches to varicocele: a systematic review and network meta-analysis. Asian Journal of Andrology, 2025. https://doi.org/10.4103/aja202541
• Chen H et al. Comparison of sclero-embolization and surgical ligation for varicocele treatment: a systematic review and meta-analysis. World Journal of Urology, 2025. https://doi.org/10.1007/s00345-025-06014-4

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