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with a long-term follow-up. Moreover, there is still a debate as to the effects of varicocele repair on testosterone levels in eugonadal men. It has been our experience that microsurgical varicocelectomy may improve the semen quality and androgen production in hypogonadal men with clinical varicocele. In general, these observed effects are achieved in a 3-month follow-up period. Such beneficial effects on androgen production may avoid the need of hormone replacement therapy in symptomatic individuals. Our data are in agreement with the recent observations indicating that testosterone levels are improved after microsurgical varicocelectomy in hypogonadal men even at older ages. In contrast, these effects are equivocal in men with normal testosterone levels. Microsurgical varicocelectomy performed by experienced surgeons is associated with a low risk of complications, and it has been recommended as the method of choice for treating varicocele. However, when performing varicocelectomy and vasectomy at the same operative time, great caution should be taken not to injure the deferential veins as well as cremasteric and testicular arteries. In conclusion, it seems sound to recommend microsurgical varicocelectomy aiming at improving androgen production in men with low testosterone levels. However, given the limited evidence available, controlled studies with a long-term follow-up in fertile and infertile men are still necessary to establish the true benefits of surgery in these men.

Asymptomatic male with grade 3 left varicocele and two children desiring vasectomy with low testosterone