(218) EFFECT OF MICROSURGICAL VARICOCELECTOMY ON SEX HORMONES LEVELS

Abstract Introduction Varicocele is defined as abnormal dilation of the internal spermatic veins due to incompetent venous valves, leading to venous reflux. This condition is found in 15% of all men, and its prevalence increases to 40% in men with primary infertility and to 80% in men with secondary infertility. Furthermore, clinical studies have demonstrated that this condition might impair Leydig cell function, and that varicocele repair can improve testosterone production. Objective To evaluate the effect of microsurgical varicocelectomy (MV) on serum sex hormone levels in infertile men with varicocele. Methods We reviewed a database of infertile men with palpable varicocele who underwent MV performed by a single surgeon and identified men who had preoperative and postoperative serum sex hormone data available. Total testosterone (TT), estradiol, luteinizing hormone (LH), and follicle-stimulating hormone (FSH) were measured in real-time by a solid-phase chemiluminescent immunoassay, while free testosterone (FT) levels were calculated using the validated formula of Vermeulen. The testosterone/estradiol ratio was also calculated. Descriptive statistics, paired t-test, and Wilcoxon signed-rank test were used to compare the variables before and after MV. Significance was set at p < 0.05. We performed a subanalysis including only participants with TT levels less than 300 ng/dL. Results Overall, we included 132 participants. When analyzing the entire cohort, there was a decrease in postoperative luteinizing hormone levels compared to baseline (4.8 vs. 5.2 mUI/mL, p < 0.05), and no statistically significant differences were observed concerning the other sex hormone levels. However, in the 17 participants with preoperative TT levels less than 300 ng/dL, we found increases in TT levels (205 vs. 376 ng/dL, p < 0.05) and estradiol levels (24.9 vs. 33.1 pg/mL, p < 0.05) after MV. In this subgroup, the mean increase in testosterone was 125 ± 83 ng/dL compared to preoperative levels, whereas the median increase in estradiol was 4.6 (-1.0, 11) pg/mL. No other statistically significant differences were observed regarding preoperative and postoperative sex hormone levels. Seventy-six percent of the participants with preoperative TT levels less than 300 ng/dL achieved levels higher than 300 ng/dL postoperatively. Conclusions We demonstrated that microsurgical varicocelectomy increases total testosterone levels only in men with low baseline levels of this hormone. In this scenario, 76% of men achieved levels higher than 300 ng/dL postoperatively. We also found an increase in estradiol levels in these men. Moreover, luteinizing hormone increased after the procedure. However, the clinical relevance of such changes remains unclear. Disclosure No.