T Nation

Varicocele and Testosterone


#1

I don't know anywhere else to post this, so I'm posting here. If I should submit in a different forum please let me know.

So, I guess I should get started with my story. Here's some background. I'm 19 years old and have been training for about 1.5 years, with only about 7 or 8 of those months being serious. I started out at around 160 lbs, 5 foot 10 inches. My beginning lifts were: bench-95, squat-125, deadlift-135. At the moment I weigh around 190 and lift 210 for bench, 330 squat, and 340 deadlift. My bodyfat levels ,however, are at least around 20 percent.

Around 5th grade, I began to feel pain in my left groin. It subsided and resurfaced every now and then in Middle school. I noticed that my left testicle had a wormy blob collecting around the testicle, while my right one didn't. I always felt weird about this, and somehow knew it wasn't normal, yet never said anything of it out of embarrassment.

Around 11th grade, I finally told my parents about it, and I was taken to the doctor. Turns out I had a varicocele that had developed in my left testicle. My doctor told me that nothing was wrong, many people got that, and there was little chance of infertility or anything, and so I went home and forgot about it. (Btw, to this date, my left testicle is smaller than my right)

Fastforward a couple years later to now. I'm 19 years old and fairly active, with a good diet. I have very little facial hair growing, and it's pathetic looking. My little sisters both have more arm hair than I do. I don't have the deepest voice. This has had me worrying that I have low testosterone. Ever since middle school, I've suffered from unexplainable depression and sadness, along with a total lack of motivation and drive.

Today I had an epiphany. Is it possible the varicocele around my left testicle is restricting blood flow to my teste, thereby hindering production of testosterone? I show all the signs of low testosterone. I'm not as assertive or "manly" as my peers, and I feel like I should have made much better gains in the gym than I have. I've really worked my ass off, and am weaker than some of my friends who have been training for less than I have.

I've been worrying for some time now that I may have to be on some sort of steroid for the rest of my life in order in to have normal testosterone levels. But with the realization that I have a varicocele, perhaps removing it will fix my problems? So with that in mind, here are my direct questions to you:

-Have you had a varicocele and was it operated on?
-Do testosterone levels return to normal after removing a varicocele?

tl;dr: Pretty much my dilemma is that I want to be big, strong, assertive, have a beard and not suffer from depression and anxiety. I also don't want to be infertile, which seems to result from having a varicocele. What can I do?


#2

Varicocele is well related to low testosterone and so is the substantial increase in fertility and testosterone levels after removal, especially if using microsurgery. The theory is that the extra blood vessels on the testes hampers blood backflow, meaning that there is a buildup of metabolic waste decreasing testicular function.

Talk to your doctor about removal, its a small surgery basically free from complications.


#3

Wow, that was surprisingly easy. I've really been stressing about it. My main worry is that the doctor won't operate, especially since the last time I went they said it was no big deal. I mainly want it to increase my testosterone, and hopefully help me gain some more masculine features. If I request the operation can they turn me down?


#4

Tell them that it hurts, and that you are afraid you will go infertile. Both are true, right?

Dont stress about it. 1/4 or 1/5 of males have it, so you are not alone. Not everyone is hormonally affected by it, though.

Do keep in mind that it will take several months away from heavy wheights after the surgery.


#5

Several months away from heavy weights?? Why would that be?

I'd assume it'd be a week or two of recovery.


#6

Because you have a gaping hole in your abdomen. You will be bedridden for a week or two, and after that, it will take several more weeks for everything to heal up sufficiently. Doing heavy deadlifts to early is gone leave your intestines on the floor.


#7

I have a varicocele in my left testicle too. From what I have read the overwhealming majority are in the left. Weird huh? As far as test levels are concerned my doctor seems to think it doesn't affect test at all. I was worried so I had my test levels checked and they were normal for my age. I have had the varicocele for about 15 years and hardly notice it. My left testicle is a bit smaller than my right though. I have been told this is due to the heat caused by all the extra blood around the testicle but I would also assume it's a blood supply issue. I have considered surgery but since there is a small risk of losing the testicle all together I figure if it doesn't hurt and it's not affecting my test levels then I will leave it for now.


#8

Hmmmm. Well I have my appointment with the Urologist tomorrow and I'll find out my test levels and see if surgery is worth it. I've heard the surgery is relatively low risk, never heard anywhere you could lose a testicle.

Also, my left one is smaller than my right as well. Wouldn't common sense dictate then that the left is producing less testosterone than the right? I'd rather just get it removed than risk faulty blood flow and disrupted hormones.

Also, how well do you grow facial hair?


#9

From what I understand when one testicle is underproducing the other actually compensates for it. Just like if you have cancer and lose a testicle you can still have normal testosterone levels due to the other testicle working twice as hard.

The thing about losing a testicle through surgery was explained to me by a doctor when I was first diagnosed. He said that when you cut away the excess blood vessels there's a small chance you can lose all blood supply to the testicle. I'm not sure if technology has advanced since then though.

I grow facial hair just fine. Good luck.


#10

Thank you. As to your first statement, my doctor told me the same thing. He said the other testicle will compensate for testosterone production. But remember to doctors normal testosterone levels are anywhere between 250-1000. That's quite a large range.

I also asked him about dangers of the surgery. He's performed many and says there is virtually no danger at all, be it surgery or embolization.

He also told me not to worry about testosterone levels. But my left testicle is clearly smaller than my right and I feel the symptoms of low test.

It's so frustrating. I think I'm just going to get the surgery and hope my test levels normalize.


#11

I would be really interested to see how this turns out if you do get surgery, keep us posted, and good luck


#12

I dont know where these doctors get their knowledge from, but it sure as hell is not from science. Younes (2003) showed average increases along the lines of 50-100%, Su (1995) showed increases of 25% (depending on severity of the varicocele), Gat (2004) showed a 100% increase and on we go. There are plenty more including ones studies showing only little effect (usually using inferior surgical techniques), but I cannot figure out on what grounds medical personel are stating "dont worry about youre testosterone levels", when very clearly this is a thing to worry about. Especially infertile couple should look this way, as reparing the varicocele is very effective in this regard.


#13

@highlander I'll be sure to post a follow-up. I'll probably get it sometime in May. I'm currently leaning towards embolization.

@Mikael LS That sounds very promising. I'm hoping that it will make an impact. Like I said I'm almost 20 and I have sparse facial/body hair, and always feel tired. Did the studies show how long it took for testosterone levels to increase? What can I expect? Do you think it will noticeably impact my gains the next time I go to the gym?

Also, would anybody recommend the embolization over the surgery? I've read that it's less complicated and invasive, and has about the same success rate. I'm mainly worried about recurrences. I want to get this over with and not have to deal with it again.


#14

Well, most of the studies are done on infertile men and not on young guys like you. But seeing as the main reason these men were infertile to begin with is their low testosterone, i am guessing you will se at least something. Probably wont jump you to high levels, but good normal levels should definatly be possible. I had the surgery and did nothing physical for 2 months. Still, i lost very little mass and kept my strenght pretty good, something i attribute to the testosterone. I doubt that my levels were low to begin with, so I dont think anything dramatic has happened.


#15

Xiiman, it is indeed possible that your varicocele could be causing you low testosterone, however it is very unlikely. Mikael LS has made some very good points. Indeed some studies of men who were impotent / infertile and had every other possible cause excluded (other than varicocele) improved post-surgery, however I think it is important to note that unless you are having erectile dysfunction, it is unlikely that your testosterone levels are significantly affected.

Its important to remember that not all of your personality traits need come down to your testosterone levels. Here are a few facts about varicoceles;

-The cause for most varicoceles being on the left is anatomic. The left testicular vein drains into the perpendicular renal vein (it makes a 'T' intersection, so to speak), whereas the right testicle drains directly into the inferior vena cava (goes straight up all the way to the heart). Since the blood in the left testicle needs to make a 90 degree left hand turn, it is more likely to pool with blood given valvular incompetence

-The cause of infertility is NOT to do with testosterone levels being reduced. In most men with a varicocele, testosterone production is fine. The infertility stems from the requirement of spermatogenesis to be within a very very precise range. When a varicoele develops and there is an increase in blood within the testicular sac, the temperature goes up and sperm cannot be created. This has no effect on your leydig cells production of testosterone, it just effects the testosterone's ability to go on to stimulate effect sperm production.
in short, the testosterone is there, but the sperm cannot be made due to the increase in temperature

-Heavy weights after varicocele surgery is a no no for a while, as Mikael LS mentioned. During all heavy weight movements you are performing a valsalva maneuver, which increases intra-abdominal pressure. You can do one of these right now by taking a deep breath in and straining (trying to breath out without letting air escape as if going to the toilet). If you do this with your finger over your varicocele, you will feel it fill with blood. Having just had varicocele surgery, lifting heavy weights will increase intra-abdominal pressure, which can cause all sorts of problem, not to mention pain while you are healing.


#16

That's a good point about the infertility. I feel dumb for forgetting that.

Also, during my last trip to the doctor, he noted that I have two varicoceles, one in each scrotum. However, the one in the right is so small it may just be a hydrocele.

The reason I'm assuming low testosterone, aside from the noticeable characteristics associated with it, is the the fact that my left testicle has shrunk a bit compared to my right one. Is that not reason enough to suspect lowered testosterone?

Also, the Urologist said that if I got a varicocele embolization, recovery time would be about two weeks. Heavy lifting could resume at no later than 4 weeks usually.

EDIT: I should note that I have no ED whatsoever. I'm very healthy in that aspect, but remember I'm also 19. I'll also be getting my test taken soon so I can verify if my concerns are valid.


#17

If you know for sure that your testicular volume has significantly reduced, then its a reasonable assumption to make that your testosterone production has lowered. Knowing that your testicles are smaller is a pretty tricky assessment to make, since feeling them from day to day is hard to recognize a significant reduction, let alone over a period of time post varicocele development.

Embolization will get you back on the weights much much quicker and from my understanding is pretty much better in all ways; complications / recovery time. I've never seen it done, mind you, i've only seen the open form done.


#18

Intermezzo, what do you mean by "In most men with a varicocele, testosterone production is fine", when i have just showed you that men with varicocele have low testosterone that is reversible with sugery. I know it is on infertile men, but that doesnt change the conclusion. You can have a look at
Improvement in serum testosterone levels after varicocelectomy. C. Tanrikut, J. M. Choi, J. S. Rosoff,
C. J. Nelson, J. P. Mulhall, M. Goldstein. Fertility and Sterility Volume 88, Supplement 1, September 2007, Page S386
for a study on healty men. Low testosterone was prevalent in untreated individuals and there was an substantial increase in T after surgery in most cases.


#19

I developed a grade 2 Varicocele on the left side 8 years ago when I was 19. Doc said it was no big deal. Within a year the left testicle was half its former size. Over the years I noticed my stamina in the gym and in other physical activities declining.

I'm 27 now and I've had some major fatigue issues for the past 2 years. I can't work out at all anymore. I was under a lot of stress when this started getting real bad so I didn't make the connection to testosterone levels. Later I learned that stress is very bad for testosterone levels. Most docs I saw just wanted to give me antidepressants. I look like I'm in good shape from all the previous years of lifting so they never assumed low test. I got a new doc and he did test the Testosterone. Total was 324 and Free was 7.8. These are both very low for a 27 year old. I'm having some thyroid issue and pre-diabetic issues now too. Both of these are related to low testosterone. You can't use Insulin very efficiently with such low testosterone and it seems to screw with other endocrine functions like the thyroid and adrenals as well.

Newer research seems to indicate that Varicoceles can have a progressive effect on the testicle and eventually damage the Leydig Cells so that they do not respond to the LH and FSH hormones from the pituitary. I just got LH and FSH tested, but haven't seen the results yet.

"An untreated varicocele, especially when large, may cause long-term deterioration in sperm production and even testosterone production."
http://emedicine.medscape.com/article/438591-overview

I've noticed another Varicocele developing on the right side now.

The more research I do the more I see the connection between Varicoceles and low T, and all the things that Low T causes. I'm going to try to get this fixed soon, both sides. There's a specialist in my area that does the Micro-Surgery. I think that's a better way to go than emmobilization. Less chance of recurrence.


#20

Do you have any idea how long it normally takes for testosterone levels to rise after varicocele surgery?