T Nation

Varicocele - A Novel Theory

12 years ago I had an injury that caused a varicocele to form on my left testicle. Within minutes of getting the injury I had a dull ache and “dragging” sensation. Over the course of 4-6 weeks I started experiencing all kinds of symptoms. The symptoms were a mix of testosterone, hypothyroidism and what felt like “PFS”. Everything from skin issues, weight gain, low libido, ED, reduced sensitivity, etc.

I was fortunate that prior to this injury I had blood work done for something unrelated and by chance I had some thyroid and testosterone tests done. The varicocele had essentially lowered my thyroid hormone production (T4) by half, but T3 remained (for the most part) unaltered. Secondly, my testosterone had halved which correlated with the symptoms. Free testosterone was also in the gutter.

My TSH started fluctuating into the 2-3 range, where it was previously 0.6. The following study shows a clear link between subclinical hypothyroidism and ED/low libido:

The most important thing to note is free T3 concentrations remained essentially the same in SCH patients, but raising FT4 aided in recovering from low libido and ED issues. This seemed to be the case of what happened to me.

This did however pose the question - why does varicocele cause alternations in thyroid hormone production? And I think (through research) I have a link.

A lot of people assume varicocele purely impacts testicular and sex hormones, but because the left testicle is on the same drainage/vascular system as the adrenal gland, it would make sense that adrenal hormones would also get messed up as well, which could de-regulate thyroid hormone production. This article confirm this theory:

The results of adrenal functional studies demonstrate a significant tendency to adrenal hypersynthesis of aldosterone and cortisol in patients with varicocele. A correlation demonstrated between peripheral blood cortisol level and the proportion of spermatozoa with abnormal headpiece structure in the ejaculate has suggested a cause-and-effect relationship between adrenal dysfunction and infertility in patients with varicocele.

This makes sense, because I had the opposite of fatigue symptoms after the varicocele incident where it felt like I was operating with high cortisol (sugar cravings, weight gain, skin issues, etc). High cortisol is also known to increase rt3, which was the case for me (and a lot of other varicocele sufferers). I believe this is why a lot of guys who go on TRT with testicular issues (or injuries) don’t see much resolution of symptoms because the effect of testosterone is “blunted” by cortisol.

Additionally, thyroid hormone cannot do it’s job due to rt3 in the cells.

The bigger question is how should this be treated? Because the “cause” of high rt3 is essentially anatomical in nature, surgery can be used to improve blood flow but isn’t really the answer. My feeling is slowly increasing thyroid hormone using NDT/Armour is probably the best route and something I will document here. Hypothyroidism by it’s nature causes high cortisol, so potentially fixing that may resolve the symptoms.

I am currently on TRT, but as mentioned - not seeing much in the way of improvements so adrenal/thyroid is definitely to blame. This is actually one of the reasons why TSH cannot be trusted as a marker, because abnormal adrenal function can lower it.

Out of curiosity

Do you have thyroid levels from the time period between the injury and pre TRT?
Can you post all of the results?

I looked up my 20 years of blood work. Had a large varicocele left and a smaller one on the right side. Thyroid levels are comparable between before successful surgery (6 years ago) and before starting TRT. Only now on TRT T4 is below ref range with T3 at about 70% of the range and TSH essentially unchanged. Libido skyrocket upon start of TRT (random erections without any obvious stimulant) and is now in a good spot, def higher then before TRT.

I do, I will post them today! My T4 essentially halved from being healthy to post-varicocele. Can you post your labs and protocol?

@davidsherlockio
Not sure if you’re still on here but thought you’d be interested in the results I just got back from nut ultrasound.