TRT or Varicocele Surgery First?

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    TRT or Varicocele Surgery First?


    My testosterone has averaged in the low 300's. I just finished a 10wk doctor prescribed clomid therapy. Last day of the drug, I had a blood test. I was only Total T 550 and low bioavailable. I am retesting in a month...I'm willing to bet it will drop down to 300's again. I never felt much better on the clomid, a little libido increase...which is gone now that I'm off for two weeks.

    I have a stage III varicocele in my left testicle.

    I've had a pre-operation meeting and can have the surgery whenever I choose.

    My question to anyone that can help: If my next blood test reveals dropped levels again, is it pointless to do the surgery? I'm doubting that fixing my varicocele will double my testosterone...additionally if I require TRT to bring up my levels, its going to make me infertile anyhow.

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    With a stage three why not try the surgery first? In the varricocele thread there were a couple who said they felt much better afterward. I think the fact your levels raised while on clomid is a good sign even if not really high. They could be responding that way because of your varicocele? Maybe get the surgery, a few months later do a more detailed list of bloodwork and then decide. I remember one of your other posts you said you lh was elevated then when you retested it was low so you thought you were secondary. I think if the varicocele is the main culprit your lh would be elevated. Maybe your puzzle has a bunch of pieces and the varicocele is just one. Another thing is if you go on trt you can still remain fertile if you use low dose hcg.
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    I also have a varicocele along with low mid-range test. ive done a lot of research and it seems that fixing the varicocele results in about a 30% increase in testosterone. I remember reading an abstract stating that the average total test 300 went up to 400 after surgery. Here is a report saying free test rose 70%! After reading this i think i am def going with the surgery next time i see my urologist.

    Elevation of serum testosterone and free testosterone after embolization of the internal spermatic vein for the treatment of varicocele in infertile men.
    Gat Y; Gornish M; Belenky A; Bachar GN
    Author's Address:
    Andrology Unit, Department of Obstetrics & Gynecology, Rabin Medical Center, Beilinson Campus, Petah Tiqva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
    Source:
    Human Reproduction (Oxford, England) [Hum Reprod] 2004 Oct; Vol. 19 (10), pp. 2303-6. Date of Electronic Publication: 2004 Aug 06.

    BACKGROUND: To evaluate the effect of internal spermatic vein (ISV) embolization on levels of serum testosterone and free testosterone and on spermatogenesis. METHODS: The files of 83 infertile men treated for varicocele were reviewed for changes in serum testosterone, free testosterone and spermatogenesis after ISV embolization. RESULTS: Mean serum testosterone concentration rose after embolization by 43%, from 12.07 +/- 6.07 nmol/l to 17.22 +/- 8.43 nmol/l (P<0.001). Mean serum free testosterone concentration rose by 72%, from 5.93 +/- 2.44 nmol/l to 10.21 +/- 7.69 nmol/l (P<0.001). Mean sperm concentration increased from 7.49 +/- 1.73 x 10(6)/ml to 18.14 +/- 2.36 x 10(6)/ml (P<0.001); mean sperm motility increased from 21.74 +/- 2.47 to 34.47 +/- 2.27% (P<0.001); and mean sperm morphology increased from 6.63 +/- 1.07 to 13.08 +/- 1.44% (P<0.001). CONCLUSIONS: ISV embolization apparently induces an increase in both serum testosterone and free testosterone concentrations and in sperm parameters in infertile patient with varicocele, regardless of the size of the varicocele.
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