In this retrospective cohort study, we aimed to evaluate the impact of varicocelectomy on hormonal and semen parameters in patients aged under 21 and over 30 years. Our findings revealed that postoperative testosterone levels increased significantly only in group 2, while FSH levels remained higher in this group compared to group 1. Notably, both age groups exhibited significant improvements in semen parameters postoperatively. These results suggest that early varicocelectomy in adolescents may not be necessary, as hormonal improvements are more pronounced in older patients. This study contributes to the ongoing debate regarding the optimal timing of varicocelectomy in adolescents, providing evidence that supports a more conservative approach in younger individuals.
Our findings align with previous studies indicating that varicocelectomy can lead to improvements in hormonal profiles, particularly testosterone levels, in older patients. For instance, a meta-analysis by Cannarella et al. demonstrated significant increases in serum testosterone levels post-varicocelectomy, with a mean difference of 82.45 ng/dL, especially in patients with baseline testosterone levels below 300 ng/dL (9). Similarly, a prospective cohort study reported that patients with FSH levels ≤10 mIU/mL experienced increased testosterone levels and improved semen quality after varicocelectomy (10).
While both age groups in our study demonstrated improvements in semen parameters, the lack of significant hormonal changes in the younger cohort raises questions about the necessity of early surgical intervention. This may be explained by the fact that in patients with varicocele, Sertoli cell dysfunction and decreased inhibin B levels lead to compensatory elevations in serum FSH levels. In this context, elevated FSH may be considered an indirect marker of germ cell damage. Additionally, patients with higher FSH levels have been shown to exhibit greater postoperative increases in testosterone following varicocelectomy (11). In our study, the absence of elevated FSH in the adolescent group may indicate that germ cell damage had not yet fully manifested in this population, thus potentially explaining the limited hormonal response. This observation is consistent with the notion that the hormonal benefits of varicocele repair may become more prominent once subclinical testicular damage has progressed. It also underscores the importance of hormonal assessment in the clinical decision-making process for varicocelectomy, particularly in younger patients (12).
Several studies have explored the outcomes of varicocelectomy in adolescents. A study by Van Batavia et al. found significant correlations between hormone levels and semen parameters in adolescents with varicocele, suggesting that hormonal evaluation can be a useful tool in assessing the severity of varicocele and the need for surgical intervention (13). Another study by Zhou et al. reported that adolescents with varicocele who underwent varicocelectomy showed improvements in semen parameters, including sperm count, motility, and morphology (14). However, the degree of improvement varied among individuals, highlighting the need for individualized assessment and treatment planning.
In contrast, some studies suggest that conservative management may be appropriate for certain adolescents with varicocele. A study by Bogaert et al. found that 85% of adolescents with uncorrected varicoceles managed with observation achieved paternity, a proportion similar to the 78% of men whose varicoceles were repaired (15). This finding suggests that not all adolescents with varicocele require surgical intervention, and that careful monitoring may be sufficient in some cases.
Given the variability in outcomes and the potential risks associated with surgery, it is essential to consider multiple factors when deciding on the management of varicocele in adolescents. These factors include the severity of the varicocele, the presence of symptoms, testicular volume, hormone levels, and semen parameters. A comprehensive evaluation can help identify adolescents who are most likely to benefit from surgical intervention and those who may be managed conservatively. Our findings may also highlight the importance of routinely incorporating baseline FSH and testosterone assessments in the initial evaluation of adolescents with varicocele, to enhance risk stratification and guide clinical decision-making.
It is important to note that our study has certain limitations. The retrospective design may introduce selection bias, and the relatively small sample size, especially in group 1, may limit the generalizability of our findings. Additionally, the follow-up period was limited to 6-12 months postoperatively, which may not capture long-term outcomes and even future fertility rates of each group. Another notable limitation is the absence of inhibin B level analysis, which is a major determinant of Sertoli cell dysfunction and a key regulator of the hypothalamic-pituitary-gonadal axis. Future prospective studies with larger cohorts and extended follow-up periods are warranted to validate our findings and further elucidate the age-related effects of varicocelectomy on hormonal and semen parameters.
DISCUSSION
In this retrospective cohort study, we aimed to evaluate the impact of varicocelectomy on hormonal and semen parameters in patients aged under 21 and over 30 years. Our findings revealed that postoperative testosterone levels increased significantly only in group 2, while FSH levels remained higher in this group compared to group 1. Notably, both age groups exhibited significant improvements in semen parameters postoperatively. These results suggest that early varicocelectomy in adolescents may not be necessary, as hormonal improvements are more pronounced in older patients. This study contributes to the ongoing debate regarding the optimal timing of varicocelectomy in adolescents, providing evidence that supports a more conservative approach in younger individuals.
Our findings align with previous studies indicating that varicocelectomy can lead to improvements in hormonal profiles, particularly testosterone levels, in older patients. For instance, a meta-analysis by Cannarella et al. demonstrated significant increases in serum testosterone levels post-varicocelectomy, with a mean difference of 82.45 ng/dL, especially in patients with baseline testosterone levels below 300 ng/dL (9). Similarly, a prospective cohort study reported that patients with FSH levels ≤10 mIU/mL experienced increased testosterone levels and improved semen quality after varicocelectomy (10).
While both age groups in our study demonstrated improvements in semen parameters, the lack of significant hormonal changes in the younger cohort raises questions about the necessity of early surgical intervention. This may be explained by the fact that in patients with varicocele, Sertoli cell dysfunction and decreased inhibin B levels lead to compensatory elevations in serum FSH levels. In this context, elevated FSH may be considered an indirect marker of germ cell damage. Additionally, patients with higher FSH levels have been shown to exhibit greater postoperative increases in testosterone following varicocelectomy (11). In our study, the absence of elevated FSH in the adolescent group may indicate that germ cell damage had not yet fully manifested in this population, thus potentially explaining the limited hormonal response. This observation is consistent with the notion that the hormonal benefits of varicocele repair may become more prominent once subclinical testicular damage has progressed. It also underscores the importance of hormonal assessment in the clinical decision-making process for varicocelectomy, particularly in younger patients (12).
Several studies have explored the outcomes of varicocelectomy in adolescents. A study by Van Batavia et al. found significant correlations between hormone levels and semen parameters in adolescents with varicocele, suggesting that hormonal evaluation can be a useful tool in assessing the severity of varicocele and the need for surgical intervention (13). Another study by Zhou et al. reported that adolescents with varicocele who underwent varicocelectomy showed improvements in semen parameters, including sperm count, motility, and morphology (14). However, the degree of improvement varied among individuals, highlighting the need for individualized assessment and treatment planning.
In contrast, some studies suggest that conservative management may be appropriate for certain adolescents with varicocele. A study by Bogaert et al. found that 85% of adolescents with uncorrected varicoceles managed with observation achieved paternity, a proportion similar to the 78% of men whose varicoceles were repaired (15). This finding suggests that not all adolescents with varicocele require surgical intervention, and that careful monitoring may be sufficient in some cases.
Given the variability in outcomes and the potential risks associated with surgery, it is essential to consider multiple factors when deciding on the management of varicocele in adolescents. These factors include the severity of the varicocele, the presence of symptoms, testicular volume, hormone levels, and semen parameters. A comprehensive evaluation can help identify adolescents who are most likely to benefit from surgical intervention and those who may be managed conservatively. Our findings may also highlight the importance of routinely incorporating baseline FSH and testosterone assessments in the initial evaluation of adolescents with varicocele, to enhance risk stratification and guide clinical decision-making.
It is important to note that our study has certain limitations. The retrospective design may introduce selection bias, and the relatively small sample size, especially in group 1, may limit the generalizability of our findings. Additionally, the follow-up period was limited to 6-12 months postoperatively, which may not capture long-term outcomes and even future fertility rates of each group. Another notable limitation is the absence of inhibin B level analysis, which is a major determinant of Sertoli cell dysfunction and a key regulator of the hypothalamic-pituitary-gonadal axis. Future prospective studies with larger cohorts and extended follow-up periods are warranted to validate our findings and further elucidate the age-related effects of varicocelectomy on hormonal and semen parameters.