Impact of Varicocele on Reproductive Hormones in Men: A Systematic Review and Meta-Analysis
Year: 2025
Type: review
Study designs: Systematic Review, Meta-Analysis
Abstract: PURPOSE: The impact of varicocele on testicular function remains debated. This systematic review and meta-analysis evaluated its effects on reproductive hormones, testicular volume, and semen parameters. MATERIALS AND METHODS: A comprehensive search was conducted in PubMed and Scopus for studies published up to January 2025, following the PECO model: Population-adult men; Exposure-varicocele; Comparator-men without varicocele; Outcomes-reproductive hormone levels, testicular volume, and semen quality. RESULTS: Of 1,622 records, 32 studies met the inclusion criteria. Men with varicocele had significantly higher follicle-stimulating hormone (FSH) (mean difference [MD] 2.18 IU/L, 95% confidence interval [CI] 1.37-2.99, p<0.001) and luteinizing hormone (LH) levels (MD 0.63 IU/L, 95% CI 0.08-1.17, p=0.02), and significantly lower total testosterone (MD -0.71 ng/mL, 95% CI -1.20 to -0.23, p=0.004). No significant differences were observed in free testosterone, prolactin, or estradiol levels between men with and without varicocele. However, testicular volume was significantly reduced in the varicocele group-both on the right (MD -1.40 mL, 95% CI -2.69 to -0.12, p=0.03) and left side (MD -2.97 mL, 95% CI -4.03 to -1.91, p<0.001). Men with varicocele also had significantly lower sperm concentration (MD -34.72 ×10⁶/mL, 95% CI -48.41 to -21.03, p<0.001), motility (MD -20.62%, 95% CI -29.69 to -11.55, p<0.001), vitality (MD -14.75%, 95% CI -24.60 to -4.90, p=0.003), and normal morphology (MD -10.15%, 95% CI -16.53 to -3.78, p=0.002). CONCLUSIONS: Varicocele is associated with elevated FSH and LH levels, alongside reductions in total testosterone, testicular volume, and semen quality. These findings indicate a detrimental effect on both spermatogenesis and Leydig cell function. Clinicians should consider these hormonal and functional impairments when evaluating and managing infertile men with varicocele.
DOI: 10.5534/wjmh.250207
Institutions: Université Ibn Zohr, University of Garmian, Cairo University, University of Algiers Benyoucef Benkhedda, Sohag University, Arabian Gulf University, Max Super Speciality Hospital, Iran University of Medical Sciences, Jilin University, All India Institute of Medical Sciences, Mansoura University, Farwaniya Hospital, Cleveland Clinic, University of Catania, Weill Cornell Medical College in Qatar, Weill Cornell Medicine, Hamad Medical Corporation, Sir H.N. Reliance Foundation Hospital and Research Centre, Lilavati Hospital & Research Centre
Language: English
Subfield: Reproductive Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4416675876