Varicocele and Low Testosterone: What Every Man Needs to Know

Introduction: Why Understanding Varicocele and Testosterone Matters

Many men experience health problems that are difficult to talk about. One of these problems is low testosterone. Another is a condition called varicocele. Both of these issues are common, and they can sometimes happen at the same time. When that happens, it can affect a man’s health in many ways. Understanding how varicocele and low testosterone are connected can help men make better decisions about their health.

Testosterone is an important hormone in the male body. It plays a key role in many physical and mental processes. Testosterone helps with sex drive, energy levels, muscle strength, mood, and the ability to have children. When testosterone levels are too low, men may feel tired, weak, sad, or have trouble with sex. They may also notice changes in body fat, hair growth, or sleep. Low testosterone, also called hypogonadism, can affect men at any age, but it is more common as men get older.

A varicocele is a swelling of veins inside the scrotum. These veins carry blood from the testicles back to the body. If the valves in these veins stop working properly, blood can flow backward and pool in the veins. This makes them larger and causes a varicocele. It can feel like a bag of worms under the skin. Varicoceles are most often found on the left side of the scrotum and usually develop during puberty. They can affect about 15 out of every 100 men.

For many years, doctors have known that varicoceles can affect male fertility. They can lower sperm count, reduce sperm movement, and change the shape of sperm. But now, more research shows that varicoceles can also affect how much testosterone the body makes. This happens because the testicles, which produce testosterone, can be harmed by the extra heat and pressure caused by varicoceles. The small cells inside the testicles, called Leydig cells, are in charge of making testosterone. If these cells do not work well, testosterone levels may drop.

This is why it is important to understand the link between varicocele and low testosterone. Both conditions can affect how a man feels, how his body works, and whether he can have children. The connection between the two may not always be clear. Some men with varicocele may not notice any symptoms. Others may feel pain or heaviness in the scrotum. Some men may go to the doctor for low testosterone and later find out they also have a varicocele.

The good news is that both varicocele and low testosterone can be treated. In some cases, fixing the varicocele can help increase testosterone levels. In other cases, men may still need more treatment for low testosterone. Knowing when to treat and what options are available depends on the cause, the symptoms, and the goals of the patient.

This topic is important because many men are searching for answers. Questions like “Can a varicocele cause low testosterone?” or “Will surgery fix my hormone levels?” are common online. There is a lot of confusion and even misinformation. It helps to have clear, simple facts based on good medical studies.

By learning more about what causes varicoceles, how they affect testosterone, and what treatments are possible, men can take control of their health. Whether the concern is fertility, energy levels, or general well-being, the first step is to understand what is going on inside the body. That way, problems can be treated early before they get worse. Doctors who work with men's health—like urologists and endocrinologists—can help find the right path forward.

Taking the time to learn about varicocele and testosterone is not just about solving one problem. It’s about improving quality of life, protecting long-term health, and helping men feel like themselves again.

What Is a Varicocele?

A varicocele is a medical condition where the veins in the scrotum become enlarged. These veins are part of a network called the pampiniform plexus, which is located above the testicles. In a healthy body, these veins carry blood from the testicles back to the heart. When a varicocele forms, blood does not flow properly through these veins. Instead, it pools or collects, causing the veins to stretch and swell.

Varicoceles are often described as feeling like a “bag of worms” in the scrotum. They are similar to varicose veins that people get in their legs. These enlarged veins can be seen or felt, especially when standing or straining.

How Common Are Varicoceles?

Varicoceles are very common. They affect about 15 out of every 100 males, especially during the teenage years and early adulthood. They are more likely to appear between the ages of 15 and 25. Many men do not even know they have a varicocele because they may not feel any pain or notice any changes. However, in some cases, a varicocele can lead to problems with fertility or hormone levels, including low testosterone.

Why Do Varicoceles Form?

Varicoceles happen when the valves inside the scrotal veins stop working properly. Normally, these valves keep blood flowing in one direction—upward toward the heart. If the valves become weak or damaged, blood flows backward and builds up in the veins. Over time, this pressure causes the veins to stretch and form a varicocele.

The left side of the scrotum is where most varicoceles occur. This is because the left testicular vein connects to a larger vein at a sharp angle, making it harder for blood to flow smoothly. This anatomical difference makes the left side more likely to develop problems.

Grading of Varicoceles

Doctors use a grading system to describe how large or severe a varicocele is. This system has three main grades:

• Grade I (Small): The varicocele is not visible and can only be felt during a special physical test called the Valsalva maneuver, where the person is asked to bear down or hold their breath and push. 
• Grade II (Moderate): The varicocele is not visible but can be easily felt by touch without any special effort. 
• Grade III (Large): The varicocele is clearly visible through the skin and can also be easily felt. 

In some cases, doctors may also use imaging, such as an ultrasound, to help determine the size and exact location of the varicocele, especially if it cannot be felt during a physical exam.

Left-Sided vs. Right-Sided Varicocele

Most varicoceles occur on the left side, but they can also happen on the right side or both sides at once. A varicocele on the right side alone is less common and may need further investigation to rule out other medical problems, such as a blockage or mass.

Signs and Symptoms

Not everyone with a varicocele has symptoms. When symptoms do happen, they may include:

• A dull ache or pain in the scrotum, especially after standing or physical activity 
• A feeling of heaviness or discomfort in the testicle 
• Visible or enlarged veins in the scrotum 
• Shrinking of the affected testicle (known as testicular atrophy) 
• Fertility problems or changes in hormone levels over time 

Why Varicoceles Matter

Even though many varicoceles do not cause pain or health issues, some can lead to low testosterone levels, reduced sperm production, or poor sperm quality. These effects may result in trouble with fertility or changes in mood, energy, and sexual function. That is why it is important to understand varicoceles and how they affect the body, especially when connected to hormone levels.

Understanding what a varicocele is—and how it works—is the first step in recognizing its possible impact on testosterone and overall male health.

What Is Testosterone and Why Is It Important?

Testosterone is a hormone made mainly in the testicles. It is often called the “male sex hormone” because it plays a big role in male growth and development. While women also have small amounts of testosterone, men have much higher levels. Testosterone affects many parts of the body and helps with both physical and mental health.

How the Body Makes Testosterone

Testosterone is made through a system called the hypothalamic-pituitary-gonadal axis. This system starts in the brain. The hypothalamus sends a signal to the pituitary gland, which is a small gland located just below the brain. The pituitary gland then releases hormones called LH (luteinizing hormone) and FSH (follicle-stimulating hormone). LH travels through the bloodstream to the testicles and tells special cells called Leydig cells to produce testosterone.

Most of the testosterone in the blood is bound to proteins, such as sex hormone-binding globulin (SHBG). A small amount is free, or “unbound,” and this free testosterone is what the body can use. Doctors may check both total testosterone and free testosterone to see if the body has enough of this hormone.

What Testosterone Does in the Body

Testosterone has many important jobs. It starts working even before birth. During pregnancy, testosterone helps form male sex organs in the fetus. After birth and during childhood, testosterone levels stay low until puberty. Then, around age 10 to 14, levels rise quickly. This causes the changes people see in teenage boys.

Here are the main functions of testosterone:

• Helps Develop Male Features: Testosterone causes the deepening of the voice, growth of facial and body hair, and increase in height during puberty. It also helps the penis and testicles grow. 
• Builds Muscle and Bone: Testosterone increases muscle size and strength. It also supports bone growth and keeps bones strong by helping the body use calcium properly. 
• Affects Sexual Function: Testosterone plays a big part in sex drive (libido). It also helps with normal erections and supports sperm production in the testicles. 
• Regulates Mood and Energy: Healthy testosterone levels are linked to better mood, focus, and energy. Low levels can lead to feelings of tiredness, sadness, or lack of motivation. 
• Supports Red Blood Cell Production: Testosterone helps the bone marrow make red blood cells. These cells carry oxygen through the body. 
• Maintains Body Fat Balance: Testosterone helps control fat distribution. Men with low levels may have more body fat, especially around the belly. 

Normal Testosterone Levels

Testosterone levels can change depending on the time of day. They are usually highest in the morning. In healthy adult males, normal total testosterone levels range from about 300 to 1,000 nanograms per deciliter (ng/dL). Levels below 300 ng/dL may be a sign of low testosterone, also known as hypogonadism.

Free testosterone levels can also help tell if the body is making enough usable hormone. Normal free testosterone levels are about 9 to 30 nanograms per deciliter (ng/dL), depending on the lab and test method.

What Causes Low Testosterone

There are many reasons testosterone levels may drop. These include:

• Age: Testosterone levels often begin to drop slowly after age 30. 
• Injury or Infection: Damage to the testicles can lower testosterone production. 
• Medical Conditions: Diseases such as obesity, type 2 diabetes, and certain pituitary problems can affect hormone levels. 
• Varicocele: Swollen veins in the scrotum can raise the temperature around the testicles and interfere with hormone production. 

Some medications, such as steroids or chemotherapy drugs, can also affect how much testosterone the body makes.

Why Testosterone Matters for Health

Testosterone affects nearly every system in the male body. When levels are too low, it can lead to many problems. These include low energy, reduced strength, poor sleep, low mood, decreased sex drive, and trouble concentrating. Over time, low testosterone can also lead to weaker bones and muscle loss.

Keeping testosterone in a healthy range supports better overall health, improves quality of life, and helps maintain fertility. Understanding what testosterone is and how it works is important for recognizing problems early and finding the right treatment.

How Can a Varicocele Affect Testosterone Levels?

A varicocele can affect how the body makes testosterone. This happens through several physical changes inside the scrotum. These changes may harm the cells in the testicles that are responsible for making testosterone. Over time, this can lead to low testosterone levels in the blood. Understanding how a varicocele causes this problem can help explain why some men with varicoceles have symptoms of low testosterone.

Higher Scrotal Temperature

One of the most important effects of a varicocele is the rise in temperature in the scrotum. The veins in the scrotum help cool the blood before it reaches the testicles. When a varicocele forms, blood does not flow properly. This causes the blood to pool in the veins, which increases heat in the area. Testicles work best at a temperature that is slightly cooler than the rest of the body. If the temperature goes up, even a little, it can slow down or damage how the testicles work. This includes the work of special cells called Leydig cells, which are in charge of making testosterone.

Stress from Free Radicals (Oxidative Stress)

Varicoceles can also cause a build-up of oxidative stress in the testicles. This happens when there are too many harmful particles called free radicals in the blood and tissues. These free radicals can damage cells. In men with varicocele, poor blood flow can lower the amount of oxygen that reaches the testicles. Less oxygen allows more free radicals to build up. Over time, these harmful particles may damage Leydig cells, reduce testosterone production, and harm sperm-making cells too. The testicles become less able to work normally.

Low Oxygen Supply (Testicular Hypoxia)

Another reason a varicocele can lower testosterone is hypoxia, which means low oxygen in the tissue. The blood pooling in the enlarged veins makes it harder for fresh oxygen-rich blood to reach the testicles. Just like other parts of the body, the testicles need a steady supply of oxygen to stay healthy. Low oxygen makes it harder for Leydig cells to make testosterone. If this continues for a long time, the damage can become more serious and long-lasting.

Disruption of Leydig Cell Function

Leydig cells sit in the spaces between other cells in the testicles. Their main job is to produce testosterone when signaled by hormones from the brain. These signals come from the pituitary gland and include luteinizing hormone (LH). In a healthy man, LH travels in the blood to the testicles and tells the Leydig cells to make testosterone. But when there is heat, oxidative stress, or low oxygen due to a varicocele, the Leydig cells may not respond well to LH. This means they make less testosterone even though the body is still trying to signal them.

Studies show that men with varicoceles often have lower testosterone than men without varicoceles. Research has found that even young men or teenagers with varicocele may have lower-than-average testosterone. This may not cause symptoms right away, but over time, the effect can grow stronger. In some men, the drop in testosterone can lead to symptoms like low energy, reduced sex drive, and weaker muscles.

Scientific Support

Several clinical studies support the link between varicocele and lower testosterone. In one study, men with varicocele were found to have both lower testosterone and smaller testicle size compared to men without varicocele. After some of these men had surgery to repair the varicocele, their testosterone levels improved. This shows that the connection is likely real and not just a coincidence.

Other studies suggest that the grade of the varicocele may also matter. A higher-grade varicocele usually causes more blood pooling and higher scrotal temperature. These cases are more likely to have lower testosterone levels. Lower-grade varicoceles may still affect testosterone, but not as much.

Varicoceles can lower testosterone through many changes in the testicles. The main problems include heat build-up, poor oxygen delivery, and harmful free radicals. All of these hurt Leydig cells, which are responsible for making testosterone. Research supports that this link is real and may affect a man’s health over time. Treating a varicocele may help improve testosterone levels in some cases, especially when symptoms of low testosterone are present.

What Are the Symptoms of Low Testosterone in Men With Varicocele?

Varicocele is a condition where the veins inside the scrotum become enlarged. It can affect the way the testicles work. One of the important roles of the testicles is to make testosterone. Testosterone is the main hormone that controls many parts of male health. When a varicocele affects the testicles, it can sometimes lead to low testosterone levels, also known as hypogonadism.

Low testosterone may not always show clear signs at first. However, over time, a man with a varicocele and low testosterone may start to notice changes in how his body feels and functions. These changes can happen slowly and may be easy to miss at first. Recognizing the symptoms early can help get proper testing and treatment.

Common Signs of Low Testosterone

Fatigue and Low Energy
One of the most common symptoms is feeling tired all the time. This is not just normal tiredness after a long day. It is a deep kind of fatigue that doesn't go away even after rest. Some men describe it as a lack of drive or not having enough energy to do everyday tasks. This type of tiredness may happen even with good sleep and can affect work, hobbies, or exercise.

Decreased Sex Drive (Low Libido)
Testosterone plays a big role in sex drive. When levels are low, interest in sex can decrease. This change may happen slowly or suddenly. Some men may also have fewer sexual thoughts or find it harder to feel aroused. A drop in libido that does not improve over time may be a sign of low testosterone.

Erectile Dysfunction
While varicoceles do not directly cause erection problems, low testosterone linked to a varicocele can lead to erectile dysfunction. This means trouble getting or keeping an erection firm enough for sex. Erections may happen less often or may not last as long. Other medical issues can also cause erectile dysfunction, but low testosterone should be checked if this becomes a problem.

Mood Changes and Depression
Low testosterone can affect mood and emotions. Some men may feel sad or down more often. Others may notice increased irritability or anger. In some cases, low testosterone can lead to depression. This may include losing interest in things that once brought joy, feeling hopeless, or having trouble focusing. Mental health should always be taken seriously, and hormone levels can be part of the picture.

Loss of Muscle Mass and Strength
Testosterone helps keep muscles strong. When levels drop, muscle mass and strength may go down, even without changes in exercise habits. Some men may notice they feel weaker or lose tone in their arms, legs, or chest. Lifting weights or doing physical work may become harder than usual.

Increase in Body Fat
Men with low testosterone may gain fat, especially around the belly. Some may also notice changes in how their body stores fat. This weight gain may happen even if diet and activity levels stay the same. Low testosterone can also cause gynecomastia, which is the development of breast tissue in males.

Poor Sleep
Some men with low testosterone have trouble sleeping. This can include trouble falling asleep, waking up during the night, or not feeling rested in the morning. Low testosterone can also increase the risk of sleep disorders such as sleep apnea.

Symptoms Related to Varicocele Alone

It is important to understand that not all symptoms are due to low testosterone. Some signs may come directly from the varicocele itself. These can include:

• A dull or aching pain in the scrotum 
• A feeling of heaviness or pressure in the testicle 
• Swelling or visible enlarged veins, often described as feeling like a "bag of worms" 
• Pain that gets worse with standing or physical activity 

These symptoms usually affect the left side more often than the right. They may become more noticeable after long periods of standing or during exercise.

When Symptoms Overlap

Sometimes, it can be hard to tell if symptoms are from low testosterone or from the varicocele. For example, fatigue, low sex drive, and mood changes can be linked to either issue. That is why doctors often perform a full evaluation. This usually includes a physical exam, hormone tests, and possibly an ultrasound.

Understanding the symptoms and paying attention to changes in the body is the first step. Many men live with low testosterone without knowing it. When a varicocele is also present, it is important to check hormone levels. Early treatment may help improve quality of life, sexual health, and physical strength.

How Is a Varicocele Diagnosed in the Context of Low Testosterone?

Diagnosing a varicocele and checking for low testosterone involves a careful medical evaluation. The process usually includes a physical exam, imaging tests, and blood work. Each step plays an important role in understanding how the varicocele may be affecting the body, especially hormone levels like testosterone.

Physical Examination

The first step in diagnosis often begins with a physical exam. A healthcare provider will examine the scrotum while the person is standing and lying down. This helps to detect any enlarged veins around the testicle. The veins may feel like a "bag of worms" when touched. This is because the veins in a varicocele are swollen and twisted.

During the exam, the person may be asked to perform the Valsalva maneuver. This means taking a deep breath and bearing down as if trying to push something out. This increases pressure in the belly and makes the varicocele easier to feel.

Varicoceles are usually graded by how easy they are to detect:

• Grade I: Small, only felt during the Valsalva maneuver 
• Grade II: Medium, felt without the Valsalva maneuver but not seen 
• Grade III: Large, easily seen and felt 

Most varicoceles occur on the left side, though they can be on both sides or, rarely, just on the right. If a right-sided varicocele is found, doctors often look more closely for other possible causes.

Scrotal Ultrasound

If the physical exam is unclear or if the varicocele is small, an ultrasound of the scrotum is often used. This is a painless test that uses sound waves to create images of the scrotal area. The test shows the size of the veins and how blood flows through them.

An ultrasound can confirm the presence of a varicocele and rule out other problems like a tumor or cyst. It also measures the size of the testicles, which can be smaller in men with long-term varicocele. A smaller testicle may suggest damage to the tissue responsible for sperm and testosterone production.

Sometimes, doctors use Doppler ultrasound to check how fast blood is flowing in the veins. If the blood flows backward when it shouldn’t, it may show that the valves in the veins are not working properly. This is a key sign of a varicocele.

Hormonal Testing

To check for low testosterone, blood tests are done. These usually happen in the early morning, when testosterone levels are at their highest. A total testosterone test shows the amount of the hormone in the bloodstream. If the levels are low, doctors may also order a free testosterone test. Free testosterone is the active form of the hormone that the body can use.

Other hormone levels may also be tested, including:

• Luteinizing hormone (LH): This signals the testicles to make testosterone. 
• Follicle-stimulating hormone (FSH): This helps control sperm production. 
• Prolactin and estradiol: These may also be checked if symptoms are unusual or if testosterone is very low. 

Hormone levels help doctors understand where the problem starts. If both LH and testosterone are low, the problem may come from the brain. If LH is high but testosterone is low, the issue likely lies in the testicles. This pattern can be seen in men with varicocele-related damage to the testicles.

Semen Analysis (If Fertility Is a Concern)

Men who are trying to have children may also need a semen analysis. This test looks at sperm count, shape, and movement. A varicocele can cause low sperm quality, and low testosterone can also affect sperm production.

While this test is not needed in all cases, it gives more information about how the varicocele is affecting the reproductive system. A low sperm count along with low testosterone may lead doctors to suggest treating the varicocele.

By combining a physical exam, ultrasound, and hormone tests, doctors can clearly understand how a varicocele is affecting the body. If testosterone is low and a varicocele is present, the connection is likely. This information helps guide the next steps in treatment, whether that means monitoring, lifestyle changes, or surgical repair.

Clear and complete testing ensures that nothing important is missed and that the best care plan is chosen based on the person’s symptoms and health goals.

Can Treating a Varicocele Improve Testosterone Levels?

Treating a varicocele can help increase testosterone levels in some men. This is because a varicocele can damage the cells in the testicles that produce testosterone. These cells are called Leydig cells. When the varicocele is repaired, the testicles may be able to work better, leading to higher testosterone levels.

There are different ways to treat a varicocele. The main method is varicocele repair, which is often called a varicocelectomy. This is a procedure that removes or blocks the enlarged veins in the scrotum. The goal is to restore normal blood flow and reduce the pressure and heat that affect the testicles.

How Varicocele Repair Works

Varicocele repair is done in a few different ways:

• Open surgery: A surgeon makes a small cut, usually in the groin, and ties off the enlarged veins. This is done under local or general anesthesia. A common method is the microsurgical subinguinal approach, which uses a microscope for better accuracy and fewer complications. 
• Laparoscopic surgery: This method uses tiny tools and a camera through small cuts in the abdomen. It is less common but may be used in certain cases, especially when the varicocele is on both sides. 
• Percutaneous embolization: In this non-surgical method, a radiologist inserts a small tube into a vein through the groin or neck. Then, a coil or special fluid is used to block the blood flow to the varicocele. This method is less invasive but not available in all hospitals. 

Each of these treatments has its own risks and benefits. However, they all aim to reduce the pressure on the testicles and improve their function.

Evidence That Repair Can Improve Testosterone

Several studies have looked at how varicocele repair affects testosterone levels. Many have shown that men with low testosterone may see a rise in their levels after treatment. The amount of improvement depends on several factors.

• Baseline testosterone level: Men with lower testosterone before surgery are more likely to see a bigger increase after repair. Men with normal levels may not see much change. 
• Age: Younger men often respond better to varicocele repair. As men age, the testicles may not recover as well, especially if the damage has been present for many years. 
• Varicocele grade: Higher-grade varicoceles (Grade II or III) may cause more damage, but also may show more improvement after treatment. 
• Time since onset: The longer a varicocele is left untreated, the more harm it may cause to the testicles. Early treatment can lead to better outcomes. 

In one review of studies, about 70% of men had higher testosterone levels after varicocelectomy. Some men even went from low to normal testosterone levels. However, not all men benefit. In some cases, the levels do not change much after surgery.

Current Medical Guidelines

Doctors do not always recommend surgery just to raise testosterone. Most guidelines suggest treating a varicocele if it causes pain, poor sperm quality, or testicular shrinkage. However, some experts believe that low testosterone caused by a varicocele is also a good reason to consider treatment—especially if other symptoms are present.

The American Urological Association (AUA) and the American Society for Reproductive Medicine (ASRM) support varicocele repair in men who have infertility and clinical varicoceles. There is growing support for repair in men with low testosterone, but the decision should be made case by case.

Other Benefits of Treatment

Besides helping testosterone levels, varicocele repair may also improve:

• Fertility 
• Sperm count and quality 
• Testicular size 
• Scrotal discomfort 

Improvement is not guaranteed, but many men report feeling better overall after the procedure.

Repairing a varicocele can lead to higher testosterone levels, especially in men who had low levels before treatment. The success depends on age, the size of the varicocele, and how long the problem has been present. Surgery is not always needed, but it can be helpful for men with symptoms or hormone problems. Talking to a urologist can help decide the best option based on individual needs.

Who Should Consider Varicocele Repair for Low Testosterone?

Varicocele repair is a medical procedure that can help improve testosterone levels in some men. However, not every man with a varicocele needs surgery. Deciding whether to treat a varicocele depends on several important factors. These include symptoms, testosterone levels, age, fertility goals, and how the varicocele affects overall health.

When Surgery May Be Needed

Doctors may recommend varicocele repair if a man has low testosterone levels along with other symptoms. These symptoms can include low sex drive, tiredness, poor erections, and reduced muscle mass. If blood tests confirm that testosterone is below normal, and the man also has a varicocele, surgery may be a good option.

Fertility is another reason to consider repair. A varicocele can lower sperm count and affect sperm quality. In men who are trying to have children, surgery may help improve both testosterone levels and fertility.

Pain or discomfort in the scrotum is another reason for treatment. A large varicocele can cause a dull or aching pain, especially after standing or exercising. If pain is ongoing or bothersome, surgery may help.

In some cases, men may have all three problems: low testosterone, poor sperm quality, and pain. For these men, fixing the varicocele may provide several health benefits.

Age and Timing of Surgery

Age is an important factor in deciding whether to repair a varicocele. Young men may benefit the most from surgery, especially if they have symptoms or low testosterone. Their bodies are still able to respond well, and hormone levels may improve after repair.

Middle-aged men may also benefit, especially if they want to improve their energy, mood, or sex drive. Older men may have other health issues that make surgery riskier, or they may not need treatment if symptoms are mild.

The timing of surgery matters. Waiting too long may lead to more damage to the testicles. Early treatment, especially when testosterone is already low, may help protect long-term health.

Fertility Goals

Men who plan to have children may benefit from varicocele repair. A varicocele can affect sperm production and quality, which makes it harder to get a partner pregnant. In men with low testosterone and poor semen results, repair may improve both.

Doctors often suggest surgery if a couple has been trying to conceive for over a year without success and the man has a varicocele. Studies show that surgery can lead to better sperm counts and sometimes natural pregnancies.

For men who do not want children or have completed their families, the decision to treat may depend more on hormone levels and symptoms.

Size and Grade of the Varicocele

Larger varicoceles are more likely to affect testosterone levels. These are usually easier to feel during a physical exam. High-grade varicoceles often cause more problems than smaller ones.

Men with large, visible varicoceles and low testosterone are more likely to benefit from surgery. Smaller varicoceles that do not cause symptoms may not need treatment.

When Watchful Waiting May Be Better

Some men may choose not to have surgery right away. This is called watchful waiting. If symptoms are mild and testosterone is only slightly low, a doctor may suggest regular check-ups instead of immediate treatment.

Lifestyle changes such as exercising more, losing weight, and getting enough sleep may help support hormone levels. Doctors may recheck hormone levels over time to see if they improve or worsen.

If symptoms become worse, or if testosterone levels drop further, surgery can still be done later.

Shared Decision-Making With a Doctor

Choosing whether to have varicocele repair is a personal decision. It should be made with help from a doctor who understands the risks and benefits. A full medical exam, hormone tests, and a semen analysis may help guide the choice.

Some men may do well with surgery, while others may not see much change. Talking with a urologist can help set clear expectations.

Varicocele repair is not the right choice for everyone. But for the right person, it may improve testosterone levels, reduce discomfort, and support fertility.

Can Varicocele Cause Infertility and Hormonal Imbalance at the Same Time?

A varicocele is a common condition where the veins in the scrotum become enlarged. This can lead to both infertility and low testosterone levels in some men. These two problems—trouble having children and low male hormones—can happen together because they are linked to the same part of the body: the testicles. The testicles have two important jobs. They make sperm, which is needed for reproduction, and they produce testosterone, which is the main male hormone.

How Varicocele Affects Sperm Production

The testicles need a lower temperature than the rest of the body to make healthy sperm. A varicocele can raise the temperature in the scrotum. The enlarged veins act like a pool of warm blood, which makes the area around the testicles hotter than normal. Even a small increase in temperature can harm sperm production.

This can lead to fewer sperm, slower sperm movement, or sperm that are shaped abnormally. Some men may even have no sperm at all in their semen, a condition called azoospermia. Poor sperm quality and quantity can make it harder to cause a pregnancy, which is why varicoceles are often found during fertility testing.

Studies have shown that varicoceles are present in about 15% of all men, but in 35% to 40% of men with infertility problems. This shows a strong link between varicocele and trouble having children. Fixing the varicocele through surgery or other treatments has been shown to improve sperm count and quality in many cases.

How Varicocele Affects Hormone Levels

Testosterone is made by special cells in the testicles called Leydig cells. These cells can be harmed by the same problems that affect sperm production. The increased heat, poor blood flow, and higher levels of oxidative stress caused by varicocele can damage these cells. When Leydig cells are damaged, they make less testosterone.

Low testosterone, also known as hypogonadism, can lead to many symptoms such as tiredness, low sex drive, trouble getting or keeping an erection, mood changes, and loss of muscle mass. A varicocele does not always cause low testosterone, but in some men it does.

Several studies have found that men with varicoceles tend to have lower testosterone levels compared to men without varicoceles. The lower the testosterone level, the more likely the man is to have symptoms. In some cases, fixing the varicocele can lead to a rise in testosterone. This shows that the condition may directly affect hormone production.

Why Both Problems Can Happen at the Same Time

Since the testicles produce both sperm and testosterone, damage from a varicocele can affect both functions. This means a man may have trouble with fertility and also show signs of low testosterone. The two issues are different, but they can come from the same cause.

The extent of the damage can depend on the size of the varicocele, how long it has been present, and how the body responds to it. A large varicocele that has been there for years is more likely to cause both fertility problems and low hormone levels.

Not all men with varicoceles will have these issues. Some may have normal sperm and hormone levels. Others may only have one problem. But when both low sperm count and low testosterone are found, it is important to consider the varicocele as a possible cause.

Role of Medical Testing

Doctors often check for varicocele during a physical exam. If it is found, they may order blood tests to measure testosterone and other hormones. A semen analysis is also helpful to see if sperm are affected. If both hormone levels and sperm quality are low, treatment of the varicocele may be discussed.

A varicocele can lead to both infertility and hormonal imbalance in men. The same changes in the testicles—such as increased temperature and poor blood flow—can affect both sperm-making and hormone production. Fixing the varicocele can sometimes improve both problems. Early diagnosis and proper testing can help guide treatment and improve a man’s overall reproductive and hormonal health.

How Is Low Testosterone Treated If It Persists After Varicocele Repair?

Some men who undergo treatment for varicocele notice an increase in testosterone levels afterward. However, for others, testosterone levels remain low. When this happens, there are several ways to manage and treat the condition to improve symptoms and long-term health.

Monitoring Testosterone Levels After Surgery

After varicocele repair, doctors usually check hormone levels over time. Blood tests help measure total testosterone and sometimes free testosterone. These tests are often done early in the morning, when testosterone is at its highest. Doctors may also look at other hormones, such as luteinizing hormone (LH) and follicle-stimulating hormone (FSH). These help understand how the body is responding and whether the testes are working properly.

If testosterone stays low for several months after surgery and symptoms continue, treatment may be needed. The goal is to improve quality of life, support bone and muscle health, and manage sexual or mood problems.

Lifestyle Changes That May Help

Before starting medical treatment, doctors often suggest improving certain lifestyle habits. These changes can help boost testosterone levels naturally and may reduce symptoms:

• Regular Exercise: Strength training and moderate aerobic activity can raise testosterone levels over time. Weightlifting, in particular, may increase the body's natural production of the hormone. 
• Healthy Diet: Eating a balanced diet with lean proteins, whole grains, fruits, and vegetables supports hormone health. Deficiencies in zinc and vitamin D are linked to lower testosterone. 
• Weight Management: Extra body fat, especially around the belly, can lead to lower testosterone. Losing weight may help restore hormone balance. 
• Better Sleep: Poor or short sleep can lower testosterone. Getting 7 to 9 hours of quality sleep each night is important for hormone regulation. 
• Stress Reduction: High stress raises cortisol, a hormone that can block testosterone. Deep breathing, meditation, and other relaxation techniques can help lower stress levels. 

While these steps may not raise testosterone to normal in all cases, they often help improve how the body feels and functions.

Testosterone Replacement Therapy (TRT)

When lifestyle changes are not enough and testosterone levels remain low, doctors may consider testosterone replacement therapy (TRT). This treatment gives the body extra testosterone through different methods:

• Injections: Testosterone is injected into a muscle every one to two weeks. This is one of the most common and affordable options. 
• Gels or Creams: These are applied to the skin daily. The hormone is absorbed into the bloodstream through the skin. 
• Patches: A patch containing testosterone is worn on the skin and changed daily. 
• Pellets: Small pellets are placed under the skin by a doctor. They slowly release testosterone over several months. 

Each method has pros and cons. The choice depends on personal needs, cost, and how easy the treatment is to use. Doctors monitor hormone levels and side effects during TRT to make sure the treatment is working safely.

Risks and Side Effects of TRT

While TRT can help relieve symptoms of low testosterone, it is not risk-free. Possible side effects include:

• Acne or oily skin 
• Breast swelling or tenderness 
• Increased red blood cell count (which can raise the risk of blood clots) 
• Worsening of sleep apnea 
• Lower sperm production and possible infertility 

Because TRT can reduce the body’s natural production of testosterone and sperm, it may not be the best choice for men who want to have children. In such cases, doctors may suggest other treatments like clomiphene citrate or human chorionic gonadotropin (hCG), which help the body increase its own testosterone production.

Follow-Up and Long-Term Care

Regular check-ups are important for anyone on TRT. Blood tests are done to track testosterone levels, red blood cell counts, and prostate health. Doctors also ask about changes in mood, energy, and sexual health to make sure the treatment is helping.

If testosterone stays low and treatment is needed long-term, doctors will review benefits and risks regularly. Treatment plans may change over time based on health, age, and new symptoms.

For men whose testosterone does not return to normal after varicocele repair, careful treatment with the right support can lead to better health, improved energy, and a better quality of life.

Are There Preventive Strategies for Protecting Testosterone in Men With Varicocele?

Many men with a varicocele may never have symptoms or problems. However, when varicocele does affect health, it can lead to lower testosterone levels, testicular discomfort, or even infertility. Even when testosterone levels are normal, a varicocele can still be harmful to the testicles over time. This is why prevention and early care are important.

Regular Checkups and Early Detection

One of the best ways to protect testosterone levels is to catch a varicocele early. Regular checkups with a healthcare provider can help spot changes in the testicles. A physical exam may reveal swelling, soft lumps, or veins that feel like a "bag of worms" in the scrotum. These are signs of a possible varicocele.

If there is any concern about testicular size, pain, or fertility, a doctor may order an ultrasound. This test uses sound waves to get a clear picture of the veins in the scrotum. If a varicocele is found early, it may be easier to manage before it affects hormone levels.

Healthy Lifestyle Choices

Certain habits can help support normal testosterone levels, even in men who have a varicocele. Healthy living helps the body work better and may reduce the stress placed on the testicles and hormone system.

• Maintain a healthy weight: Being overweight can lead to lower testosterone. Extra fat tissue increases the conversion of testosterone into estrogen. It also causes more inflammation in the body, which can hurt hormone balance. Losing weight through diet and regular exercise can help improve testosterone levels naturally. 
• Eat a balanced diet: Foods rich in vitamins and minerals support hormone production. Zinc and vitamin D are especially important for testosterone. Foods like lean meats, eggs, nuts, leafy greens, and fatty fish can help. Avoiding processed foods, sugary drinks, and too much alcohol also supports testicular and hormonal health. 
• Get regular exercise: Physical activity, especially strength training, can help boost testosterone levels. Exercise improves blood flow and reduces stress, both of which are good for testicular health. Men who are not active may see a drop in testosterone over time. 
• Sleep well: Poor sleep affects the body’s ability to make testosterone. Getting 7 to 9 hours of quality sleep each night is important. Men who do not sleep enough may have lower hormone levels and more symptoms like tiredness and low sex drive. 
• Avoid smoking and limit alcohol: Both smoking and heavy alcohol use can harm the testicles and lower testosterone. Quitting smoking and drinking only in moderation can protect hormone health. 

Protect the Testicles from Heat

Varicocele raises the temperature around the testicles. High temperature in this area can damage the cells that make testosterone. This is why extra heat should be avoided.

• Wear loose underwear: Tight briefs or pants can trap heat around the testicles. Wearing boxers or loose-fitting clothes allows better air flow and helps keep the scrotum cool. 
• Avoid hot environments: Hot tubs, saunas, and long baths raise scrotal temperature. Reducing time spent in these hot settings can help protect testicular function. 
• Take breaks when sitting for long periods: Sitting for many hours may raise the temperature in the groin area. Taking short breaks to stand or walk can help reduce heat buildup. 

Follow Up with a Specialist

Men diagnosed with a varicocele should stay in touch with their healthcare provider or a urologist. Regular follow-up visits can track testosterone levels, sperm quality, and testicular size. If problems are found early, treatment can begin before the damage becomes worse.

In teens and young men, monitoring is especially important. A growing body may be more sensitive to hormone changes. Tracking growth of the testicles and hormone levels over time helps doctors decide if treatment is needed.

Prevention does not always mean stopping a varicocele from forming, since many are caused by body structure or genetics. But with good habits, regular checkups, and careful management, the effects of a varicocele on testosterone can often be reduced or delayed. Early action and healthy choices give the best chance for keeping hormone levels normal and avoiding future complications.

Conclusion: The Takeaway on Varicocele and Low Testosterone

Varicocele is a condition that affects many men but often goes unnoticed. It is caused by enlarged veins in the scrotum, similar to varicose veins in the legs. These veins can lead to higher temperatures in the testicles, lower oxygen levels, and damage from oxidative stress. Over time, this can harm the cells in the testicles that produce testosterone. Testosterone is an important hormone for men. It helps control muscle growth, bone strength, mood, sex drive, and fertility. When testosterone levels are too low, men may feel tired, lose interest in sex, have trouble with erections, and experience mood changes like feeling sad or irritable.

Many studies show that men with varicoceles often have lower testosterone levels than those without. This means that having a varicocele may not only affect fertility, but also cause or worsen low testosterone, a condition known as hypogonadism. This is why understanding the connection between varicocele and testosterone is important for men of all ages.

Low testosterone in men with varicocele may not always cause symptoms right away. Some men may feel normal, while others may start to notice changes slowly. Common signs include low energy, weight gain, muscle loss, trouble concentrating, and reduced sexual desire. Because these symptoms can be caused by many different things, it is important to get a medical check-up to find the real cause. A doctor can check the scrotum for signs of a varicocele and order blood tests to measure testosterone levels. If needed, an ultrasound can confirm the diagnosis and show how large the varicocele is.

Treatment may help in many cases. Surgery to fix a varicocele is called varicocelectomy. There are different ways to do this, including open surgery, laparoscopic surgery, and microscopic surgery. Another method is embolization, a non-surgical treatment that blocks the affected veins. Studies show that many men have better testosterone levels after surgery, especially if their levels were low before the procedure. Younger men and those with larger varicoceles may see the most improvement.

However, not everyone with a varicocele needs surgery. If the varicocele does not cause symptoms, or if testosterone levels are normal, a doctor may suggest regular check-ups instead. But if a man has low testosterone and symptoms that affect daily life, surgery may be a helpful option. Some men also choose surgery to improve fertility, since varicoceles can lower sperm count and quality.

In some cases, testosterone levels may stay low even after a varicocele is treated. If that happens, a doctor may recommend other treatments. These can include lifestyle changes such as losing weight, exercising, and avoiding alcohol or drugs that affect hormones. Testosterone replacement therapy (TRT) is another option for men with confirmed low testosterone and symptoms. TRT can be given in different forms like gels, patches, or injections. It can help improve energy, mood, and sex drive. However, TRT may not be suitable for all men, especially those who want to have children, because it can lower sperm production.

There are also steps men can take to protect their hormone health. These include keeping a healthy weight, staying active, getting enough sleep, and avoiding heat exposure to the testicles, like hot tubs or tight clothing. Early diagnosis and regular check-ups are also important, especially for teenagers and young men, since varicoceles often start during puberty.

Varicocele and low testosterone are health issues that are closely linked. Together, they can affect a man's well-being, fertility, and quality of life. The good news is that both conditions can be diagnosed and treated. Men who experience symptoms such as fatigue, low sex drive, or pain in the scrotum should talk to a healthcare provider. With the right care, it is possible to improve hormone levels and feel better. Understanding this connection helps men make informed choices about their health and future.