VARICOCELE...can it effect testosterone?
- 01-30-2007, 12:52 PM
- 01-30-2007, 04:53 PM
01-30-2007, 08:28 PM
I think in most cases varicoceles cause multi-factorial issues which in turn cause testicular dysfunction. Testosterone and DHT have a role in determining blood flow through the penis and testes, affecting nitric oxide production. Which links back to what Hyde said, so this in turn could explain why my nut's are for lack of a better word, going nut's. Low T in itself effects blood flow around the body and in turn could be the the cause of the atrophy. Low estridol can effect sperm production and 'technically' cause atrophy due to this. I believe high E2 can cause epididyml abnormalities and blockages when E2 is high.
Androgel (50mg) reduces my LH to 2.2 but brings my total t up to 25/6nmol. Within a few hour's my penis and testicles feel allot more healthy and fuller (for lack of a better word). Which again might back up this theory.
Some men can go through life having bi-lateral varicoceles and never have atrophy or low testosterone until allot later in life (JazSz being a good example). However the sluggish blood flow caused by the varicocele can cause over-heating and tissue damage to the testicle in the long-term.
It's important to remember that varicoceles cause, in most cases, permanent damage to the testicle, tissues and cells (leydig included - though they are alot 'tougher' than sperm production tubules). I believe when the testicles atrophy a degree of compression and a tighter area of leydig cells occur which in turn can cause some degree of dysfunction and reduced binding of the LH signals. I guess a kind of 'domino' effect occurs with varicoceles.
While there is no "average" testosterone level and everyone is different it's assumed that an inter-testicular testosterone level of 23+nmol is required for proper sperm production and transportation, so i guess when your T goes low this might explain the atrophy too. Low E2 can contribute to sperm production problems (which i have myself).
Dr John, the best research paper i have found is here:
Elevation of serum testosterone and free testosterone after embolization of the internal spermatic vein for the treatment of varicocele in infertile men -- Gat et al. 19 (10): 2303 -- Human Reproduction
I have to agree fully with you on this one, get the surgery, see how thing's go but don't expect miracles (i need to honest here, having spoken with alot of varicocele sufferers). I am pretty confident i haven't seen any improvements what so ever with the exception of reduced pain and no more swelling in the scrotum. However using TRT + HCG i am hoping i can restore thing's as i don't have full primary testicular failure. My LH/FSH are both in the normal if not 'perfect' range. Elevated LH would mean leydig cell dysfunction/atrophy.
If you come across any old patient records on the subject Dr John, i would love to hear more about your own personal experiences treating varicocele patients and how they respond to HCG. My other testicle was already atrophied due to being undescended as a child and ironically also suffered from a varicocele in my early teenage years.
01-30-2007, 08:58 PM
A long thread.
When a varicocele or other injury reduces the ability of the teste(s) to produce T, if the upper end of the HPTA is working right, then the levels of LH will be high. So in that case, taking HCG will probably not be of value as the LH levels are probably above normal range already. If this is the case and the varicocele is restored and the teste recovers circulation and is has not suffered permanent damage, then there should be enough LH on hand. But perhaps a short shock treatment of HCG might have some value (but I am not saying that that is the case).
When would HCG be of benefit with a repaired varicocele? If the top end of the HTPA is not making LH, then for HCG to be of benefit more than the testes and T, it would have to increase T levels that that might wake up the top end of the HTPA. If the HTPA is not doing the right thing, then it might be from too much E. That is where a SERM might get things going.
I have seen a few guys with this problem on another board who are now happy to be on TRT.
01-31-2007, 08:58 AM
Thanks for your reply KSMan, i think i sent you a message a little while back on t-nation?
I believe it's more based on "dysfunction" rather than full blown damage. It's difficult to really understand what happens with varicoceles and how they effect the testicle, i believe a lack of nutrients alongside sluggish blood flow are the prime causes.
My actual problems comes from having low E2/DHT. When i apply androgel (even 50mg) i go up to 25/6nmol and my ball's feel alot better. Erections aren't perfect but a good bit better than before.
KSMan, do you know of any varicocele sufferers that are using HCG alongside TRT? I want to use Testim (50mg - or more) daily alongside HCG at least 3 times a week.
01-31-2007, 05:49 PM
Megazoid, Im not sure that testosterone plays a huge part in Nitric Oxide. I have been doing more research and from what I read, most men recover from Varicoceles after the surgery. Im getting the operation in the morning. Wish me luck.
01-31-2007, 05:54 PM
You'll be cool Hyde, it's pretty straightforward and you'll be back on the forum tomorrow night i am sure (if limping a little).
Best of luck with the operation tomorrow! Let me know how it goes.
01-31-2007, 07:06 PM
If you do TRT, you will be fully LH repressed if it is effective [which for some can be problematic for some on transdermals]. Then you can/must use HCG to keep your testes from shutting down. But if not on TRT, as I stated before, the LH levels might be above normal range already as the HPTA tried to get higher T+E levels.
So there were two answers there. If not on TRT, adding HCG might take levels higher than needed, but the HPTA would probably simply reduce LH to get you back to where you were in terms of T+E status.
If you need a boost in your T levels and there is little prospect of you recovering to higher T levels on your own, then TRT+HCG seems to make a lot of sense. E will also recover and you might need AI to maintain libido and mood later. If costs are an issue, injections are certainly the least cost if you can self-inject.
If surgery and recovery make the teste(s) ready to go from a blood flow point if view, the(y) might be profit from HCG and/or SERM as would be used in PCT to kick things into gear, get the testes developed and responsive and get the HP part of the HPTA going again. When we see guys that have botched cycles and PCT who can't get their HPTA to self-recover over time, then it seems that this system can be stuck or trapped. Use if PCT methods to get things running again can work, and in some cases of varicoceles, if blood flow is normalized, then HCG could take care of physical recovery of the testes and create some T to help wake things up. A SERM would encourage resumption of LH. But for some varicoceles after surgery with good blood flow circulation, LH may be ready and willing and HCG might help, but may not be necessary.
I think that for the HPTA to be stuck, bilateral varicoceles might be needed. If one is bad, the HPTA may be working ok and a PCT approach does not seem to have any obvious benefit. The amount of time that a teste was shutdown or starved also speaks to the issue of permanent damage vs recovery. If TRT is required after all is said and done, so be it. We have seen guys [not gear users] in their 20's with very low T. These things happen.
01-31-2007, 08:00 PM
Very special thanks for the feedback guy's. Dr John, your advice is also appreciated, as is yours KSman. The sad but true fact is i am getting zero support from doctors across here and have to self-medicate which is terrible. I have found a good blood testing lab though and know enough to self-medicate myself (sometimes i think just going by "how you feel" is worthwhile - libido, morning wood, mood, etc) and doing lab's every few months to monitor progress.
Throughout all of this my LH/FSH are totally normal, even when the varicocele induced atrophy. LH has remained at 3.9 and down-regulates to 2.1 when doing androgel at 50mg daily (1 packet). My total T goes to 25nmol and E2 remains low (which i think is maybe my problem - too low E2?). I am getting fresh blood work soon to get a baseline with no TRT and then another a month or two latter with testim at 50mg daily.
Usually guy's with varicoceles (or some form of testicular failure) have elevated LH which is strange as mine is normal. My only theory is that both ball's are still somewhat responding even though they are both atrophied, i was however told they were in the "normal size limits" by a urologist. But they aren't normal size for me (they were normal, adult size before). Not to mention the fact i have ED, low libido and i am suffering all the side effects of low t.
Basically if i do HCG alone i am shooting myself in the foot but it might be worthwhile in restoring testicular size/function. I don't want to cause complete HPTA shutdown (LH = Zero) by doing HCG if it dosen't get me high enough or improve testicular health (size/function). Blood work is very expensive too and i can't afford to keep getting constant tests. A few week's back i was thinking about doing 250iu HCG daily for 3/6 weeks then running Nolvadex for 4 week's afterwards but because my HPTA seem's somewhat normal this wouldn't make sense and maybe PCT isn't the answer if my piturity is working fine. I really feel Dr John is right about this, the less stuff you take the better (plus nolvadex has IGF-1 effects which i don't want).
I was hoping to see improvements after the surgery but haven't yet (though it's still only been about 2/3 months). No size increases and no T improvements (my original level was around 25/30nmol). I am visiting the urologist again for another ultrasound and to check if thing's are working or not. While the varicocele has cleared i am still getting some pain and feel the blood is still polling around in the whole area.
In general i feel allot better on androgel but i don't like the tight scrotum effect i am getting and the reduced ejaculate volume. Is it possible for a guy to use 50mg androgel daily (or testim) and NOT get complete shutdown?
It's almost ironic Dr John because say that HCG will down regulate the leydig cells but at the same time you think TRT + HCG is a good choice I agree with this however, but i really want to try everything before giving into TRT (not saying it's a bad thing - just very expensive for me right now) assuming i have no E2 problems (i am very lean, very little body fat, good build, etc) would you recommend running your own protocol of Testim + HCG? And how much HCG a week? I was considering using Testim (50mg daily - maybe moving up to 75mg if needed) as this should get me into the 500/650 range even with HPTA shutdown and then maybe using HCG at 500iu 3 times a week (mon-wed-fri). In fact maybe lowering this to 250iu HCG would work better 3/4 times a week (mon-wed-fri-sun)?
While you can only offer your opinion (as i am not your patient - but would like to be if my doctor would work with you and not be a **** about this!) it would be appreciated as always.
01-31-2007, 08:21 PM
02-01-2007, 06:24 PM
Hi everyone. Just got done with my surgery and yes im limping around a low, it hurts like hell to stand all the way up. On a positive note, the surgery went well and they gave me about 30 percocets for pain
02-01-2007, 06:30 PM
Very pleased to hear it went well Hyde. What technique did they use and how is the scar?
Did they tie off the veins at kidney/abdominal level or scrotal level?
After you have healed, what will your plan of action be?
02-02-2007, 12:48 PM
02-02-2007, 01:01 PM
02-02-2007, 06:29 PM
I am seeing the urologist this Tuesday, i really do need luck when dealing with this guy. He can be a nightmare at times and doesn't always want to listen.
My right testicle has always been smaller and dysfunctional since having it injured as a teenager. I think it had a varicocele that magically (?) went away on it's own after a year or two. The spermatic cord has a noticable blockage though (not a varicocele) which i want fixed to see if it will restore more testicular function than present and more importantly reduce the pain. The urologist mentioned it was like a vascotemy had happened.
Regarding left side varicocele i want to get this confirmed that the operation has worked 100%. My nut's are still going nut's and i am not sure if hormones are to blame or bad blood flow. Maybe even more factors? What i am confused with even more is the fact that my LH/FSH are normal and not registering anything "abnormal". I am going to get more test's ran.
At present i am on TRT and feeling a "bit" better using one tube of testim a day. Only been 3 day's since starting Testim. It stinks though so i am going to change back to TestoGel (100mg daily) alongside HCG once everything is fixed and confirmed in the testicular department. I have a girlfriend now that i really love and i have had to refrain from sex because of these problems and because wood isn't too good (nor libido) so i am holding back.
God i hate varicoceles...
02-03-2007, 10:02 AM
02-03-2007, 12:15 PM
Varicoceles/testicles don't share the same vascular system as the penis, but they do effect hormones which effect blood flow to the penis. Maybe your T is going back up which is a good sign Hyde?
One thing i should mention is that allot of guy's that adding HCG to there TRT regiem makes everything "hang" and look better in general. Maybe Dr John can comment on this? HCG has potent effects on the whole area i think.
02-06-2007, 07:54 AM
Hyde, How are thing's progressing for you? I hope you have made some good progress over the past few days.
I am going to visit the urologist tonight and really need a good bit off luck while dealing with this guy, hopefully i can get this right side spermatic cord blockage repaired and also he can evaluate the varicocele operation i had.
What is your plan of action now?
02-06-2007, 04:37 PM
Just a quick update. I'm healing pretty quickly. I did not take any of the percocet they gave me because they contain aspirin and aspirin slows down healing. The past 4 days I have had a pretty good libido and no ED issues. For some reason today, I don't have a good libido, maybe I just need more recovery time?
02-08-2007, 12:53 AM
02-08-2007, 07:57 AM
02-09-2007, 05:14 AM
02-09-2007, 05:17 AM
02-13-2007, 07:02 PM
Hi, forum noob here.
I'd be very interested in hearing how this turns out for you, Hyde12. I believe I may be experiencing some of the same problems as the other people in the thread.
I first noticed that I had a varicocele about 1 year ago. At the time I thought nothing of it. I thought it was normal to have veins around there. Anyway, over last summer I noticed that I was getting very few spontaneous erections... once again thought nothing of it for a while. Then over the course of last fall semester I also noticed that I had stopped consistantly getting morning erections and eventually having them go away. Around the time I noticed this I noticed that my arms and shoulders just didn't seem as strong as they used to even though my exercise routines hadn't changed at all. I was getting tired and fatigued all the time and just generally felt weak. I started eating more, but I was/am still losing weight (but no fat). Basically, I just started feeling like total **** for no apparent reason. Oh, and I've had basically no sex drive.
I'd begun suspecting that I have problems with low testosterone based on 2.5 months or so of reading what I can about the subject. At the beginning of this semester I went to the doctors at the university here and told him about my erection/no libido problem. He asked me a bunch of questions and had me do a pretty extensive blood test. Most everything was either normal or really good except for a few things: 1) I had a slightly low RBC count and Hemacrit. 2)Albumin/Globulin ration was slightly high and (what I had been afraid of) 3) total testosterone of 367 ng/dl. I asked the doctor about it and he told me that my reading was totally normal (the lab range was about 240-820). I'm completely unconvinced, however. The lab range encompasses readings for a huge age range and doesn't take into account what an individual's normal levels are. I was sent away with basically no help for my problems.
Since then (last week Wednesday) I've started taking a zinc suppliment. I've noticed a slight increase in my libido and I've gotten a few weak morning erections, but obviously things still aren't too good. Tomorrow I'm going to call the local clinic to get in to see another doctor about this. I'm going to be sure to mention the varicocele and ask about the possibility of getting it repaired.
I apoligize for this rambling reply, I'm just a bit frustrated.
02-14-2007, 04:32 PM
We are here to help sammowise. It might be too easy to say the varicocele is the cause of all your problems but that would be too easy to say. I think more comprehensive blood work needs done. However varicocele won't be helping matter's that's for sure. Do you have it on one testicle or both?
I have a few questions for you:
1) Did you notice any abnormal testicular changes (shrinkage/atrophy, softness, etc) on the varicocele side?
2) Can you post up complete work including LH/FSH.
3) How big would you class the varicocele (i.e. is it visible easily)?
Your T is low and your symptoms are of low t. Lack of morning erections being a clue. I am in the same boat myself but doing TRT myself and making some improvements in strength and libido/ED.
How do you find your sexual performance/libido in general right now? Can you still get erections?
02-14-2007, 04:46 PM
02-14-2007, 06:22 PM
1) I'm pretty sure it's gotten a bit smaller, but I can't say how long it's been happening. No softness, though.
2) I will bring it up when I go to see the doctor.
3) I'm not sure what different classes are. When you pull it against the scrotum, you can definately see that there's a vein running up the side with a widened area in the middle.
On a day to day basis I have basically no libido. I'm still able to get an erection when sex comes up with my gf, but it's not as hard as I remember.
I'm visiting a urologist this Friday to bring up the general issue of hormones/me feeling like ****. I'll mention the varicocele and I'll try to keep you updated.
02-20-2007, 05:44 AM
Hey guys. I have read pretty much this entire post and i think it's awesome that you guys are helping each other out. I have a varicocele as well and I know they can be very frustrating. I was hoping that I could get your opinions on my situation. I am 21 years old and have a stage 3 varicocele over my left testicle. I've had it for around 4-5 years now. So far i have not experienced any negative effects from it besides the occasional pain. However, I realize that varicoceles cause progressive damage to the testicles so there is a good chance i may have problems in the future. Do you guys think it would be better to have the varicocele repaired before any new problems arise? After reading all of the posts I really want to take a pro-active approach. But i also wanted all of your opinions as well. If you guys were in my situation with no serious problems (no atrophy or lowered testosterone as of yet), would you get it repaired anyway? Just to be safe? Any replies will be GREATLY appreciated.
02-20-2007, 10:47 AM
If you have a stage 3 vericocele like I did, then you probably already have some atrophy in your left testicle.. My urologist sent me to have an ultrasound and they found out it was about a cm. smaller than the right testicle..
The procedure is pretty easy.. You go in and your out in a couple hours... Recovery is pretty quick, I was lifting again in 2 weeks.
02-20-2007, 06:30 PM
I have another two questions for those who have had a procudure done to remove the varicocele:
What type of procudure did you have done?
What costs could one expect for such a procedure?
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