Since I read this entire thread before and after my surgery (thank you Google), I feel like I need to give some back.
So here it goes:
Hi all,
I had my sublingual microsurgical Varicocelectomy surgery several months ago, and here is my story + tests (pre/post surgery) + progress and complications. FYI, I never used steroids, but I'm exercising (lifting) for the last 6-7 years, with major breaks in between.
First, I would like to mention that I had Varicocele since I'm 13-15 years old, and I actually had a consultation with a urologist who said it's nothing major and if it doesn't hurt, don't do anything about it.
Well, 10 years later, at 24 years old, I had severe pain on my right testicle. I always had low-mild discomfort once a month or so (mainly after exercising), but it's only lasted several minutes; and I usually didn't pay any attention to it. Anyway, I went to a urologist, and he said that there are some veins on the right side of my scrotum and a bump on my right testicle. In addition, he said that most of the time Varicocele is present on the left side, so I probably have bilateral Varicocele. He sent me to do an ultrasound on my scrotum and kidneys, a semen analysis, and a blood test for "Total Testosterone" and "Free Testosterone". The kidneys ultrasound was ordered to check if I have a tumor, since I had pain on the right side and it's quite unusual. Meanwhile, I did my semen analysis (I always imagined it as a entering to a room with a lot of porn magazines, in my case it was an iPhone, my hand, and a stinky restroom [private restroom at least]).
I went to my urologist again, and here are the results:
Ultrasound: Level 1 - Right varicocele
Kidney - Negative for the tumor
Scrotum - Grade I varicocele (the lowest) on the right side - only (no left side varicocele, quite surprising).
Blood Test:
Test Total - 347 ng/dL
Test Free - 12 pg/ML
Semen Analysis:
Sperm count: 84.5 (Million/ML)
Count/Ejaculate: 253.5 Million (> 40M is normal)
Motility: 36.5% (>50% is normal)
Rapid progressive Motility: 11.2% (>25% is normal)
To be honest, I don't care for the semen analysis, but I don't want to close the option of having kids in the future. My primary concerns are pain, and then my T levels, which are quite low.
The urologist said that patients with Grade I Varicocele usually don't do a surgery, but because my semen analysis doesn't look good and my T levels are low, a surgery can help. He said that there is a great connection between T-levels and Varicocele due to constant heating of the scrotum (which I have for years. I always sweat down there, even when it's cold. My testicles are always hanging low, and one is higher than the other, probably a way of the body to keep them cold). In addition, the urologist said that in my age, he doesn't expect T-levels lower than 600. He said that it's up to me about the surgery. He gave me some painkillers and said to contact their office if I would like to do the surgery. He also said to be on a follow up routine since it can get worse, so visit him once a year or so to see that everything is going well and nothing major is happening. Anyway, I already decided that I want a surgery, without even researching about it or checking anything. The fact that my T levels were so low, made me to get to a conclusion that something is wrong and I need to fix it. I scheduled a surgery a month and a half after that since I couldn't stop going to my classes for a week, and wanted to do it during spring break.
By the way, my urologist knows Dr. Goldstein from New-York, and he is in a good connection with him (he said that "a guy from New York came up with the sublingual microsurgical Varicocelectomy, and the recovery and the results are much better than a conventional surgery"). I asked him about embolization, and his reaction was "oh God", so I got the idea. FYI: I couldn't see the vain on my scrotum(ever), and could barely feel it when touching. I don't know if I had libido problems or not, but I wasn't so passionate about girls and sex overall. I haven't had any ED problems for sure. The major symptoms I had in the last 3 years or so was tiredness (especially after meals, since insulin lowers your testosterone even more). In addition, in the last 3 years or so, I had a lack of motivation regarding almost anything in my life. I was just leaving on a daily basis, and mainly didn't care for nothing.
Here is a surgery summary:
Day 1: I woke up pretty fast, about 10-15 minutes after my surgery and found myself in the recovery room full of nurses eating and laughing between themselves (i did that in an hospital, in South California). They were pretty good about checking me up and monitoring me (**** that blood pressure sleeve that was squeezing my arm every 10 minutes and left some marks on my hand).
I came home, was able to get to the 2nd floor of my house, and went to sleep for couple of hours. I woke up with pain (around the incision area), so I took some painkillers (hydrocodone-acetaminophen 10-325, which is a combination of Vicodin alternative (the same thing, just a different name) and a 325mg of Tylenol). I took it every 6 hours as prescribed. I had one big problem: I couldn't pee in a standing position. When I tried to pee, I got really dizzy, and had the feeling that I'm going to pass out. I also had cold sweat. I guess it was from the anesthesia. I then figured this out, and I peed while I was siting, which was better than nothing.
Day 2:
My right testicle is swollen, about twitch of its original size and hanging relay low, even lower than it was. I guess it would go away when things down there start to heal. I can barely walk and the right side of my back really hurts. I got a call from doctor's physician assistance and I asked about the back pain. She said it's probably because they put a pressure on this side during the surgery and/or because I was laying on my back a long time. I said ok, we would see what happen.
Day 3:
Things are much better with the pain. I don't take any painkillers anymore. I'm able to take a shower today and see what's going on there (until know I had a dressing that covered the entire area, so I could't really see what's going on there, except for a yellow coloring, like a bruise, around the entire area and my right-top leg).
I took the dressing out (taking the tape out was a great challenge), and had a shower. It said in the directions that the Doc and the hospital gave me (two different once, which actually conflict each other in some things that I will discuses later) not to re-apply the dressing, and keep it open to the air. It's also said to reapply the scrotum support, which I didn't get from the first place, so I guess I didn't need it. The incision is about 3cm (2in), and since the surgery was sublingual, it's really low and wouldn't be visible in the future. I did notice swelling of the groin area, right next to the incision and around it (the right side only). About the conflicting directions of the hospital and my doc: the hospital says to take an Advil (Ibuprofen) or Tylenol for the pain, and my doc said not Ibuprofen products since they can increase bleeding.
Day 4+5:
I came back to college. Walking from the parking to my class is a pain in the ass, but I read some data that says walking makes healing better since blood is circulating better in that area. Well, it took twitch the time to walk since I couldn't walk normally. I took Tylenol before going to class, just in case. After 5 hours in class, I had some pain. The pain is probably from sitting so long, and standing for an hour and a half straight during lab.
Day 6:
I went to grab something to eat, and when I came back, I tried to take a shower. I noticed a big circle of blood on my right leg, but nothing was coming out of the incision. I didn't even felt it, but I did have a burning feeling when I was walking. However, I thought it was part of the deal, so I took a shower and then, from the right side of the incision, I could see blood coming out. It was very minor, a drop or two accumulating around the incision every several minutes, but it lasted for 3-4 hours later on, until I got tired wiping it with a towel because I wanted to go to sleep.
Day 7:
I called Doc about the bleeding, which occurred again when I bended to pick something from the floor. I called pretty late on that day, so Doc didn't return my call. I could call to his personal phone, but the bleeding stopped, so I said I would wait for tomorrow. The only pain I have right now is a burning pain from the right side of the incision. The testicle is doing much better, but still sensitive to touch. It wasn't hurting just by itself since day one, just when touching, but that decreased either. It's still pretty swollen around the incision, and looks a little bit scary.
Day 8:
I called Doc in the morning, he was doing a surgery, so his physical assistance answered my call and said to come over because of my bleeding. After a quick examination, she said that I have Hematoma which is a collection of blood outside a blood vessels and tissues. It's one of the complications of the surgery (5%). She said it would go away by itself, but it would take some time (several weeks). This can happen to some patients from ligating the veins or when cutting through the layers to get to the testicle. Meanwhile she said not to put too much pressure on the abdominals (siting for example) and take it easy. In addition, she gave my antibiotics in order to be on the safe side in terms of infections although she said I don't have one. She prescribed me Cephalexin 500mg, 4 times a day for 7 days. I have another appointment, this time with the Doc next week. I was directed to some sort of dressing on the incision to soak the blood and keep the incision clean. It looks like the paint got worse on the incision area, since the PA pressed to feel my groin, and blood starting to come out. I have the burning feeling again and can nearly walk, but it's not near of whatever I had on the first two days.
Day 9:
Some discomfort in the right testicle, but nothing major. It happens only when something touches it, so I guess it's because of the surgery. It's still quite swollen and the scrotum shows signs of veins or some weird lines on the walls (I didn't have any visible veins before the surgery). I still have some blood going from the incision, and I'm still replacing the dressing after every shower. It looks like the bleeding goes right after I finish to take a shower. I don't scrub the area on anything, oh well.
Day 10:
It looks like I'm getting better. I can walk straight, but I'm still quite slow. As I mentioned, I'm going to school since day 4, which I would not recommend. I would say stay home at least a week( or 10 days would be even better). However, the recovery part is really a case by case basis, and any recommendation here is based on my experience only.
Day 11:
I took a shower to replace the dressing, and I saw some stitches on the dressing itself. The stitches are suppose to dissolve by themselves, so I guess it's part of the process. I had only traces of blood and it's quite hard to tell since I'm covering the incision with Iodine that I got from my urologists every time I replace the dressing. I can walk way better now, but It's still quite difficult to get up from a sitting position, and siting overall is uncomfortable. There is a mild discomfort around the incision line, but nothing major. I haven't taken any pain medications since day 2, and I guess I don't need them anymore. I do take the antibiotics (4X500mg/day). My last antibiotics dose would be on day 16 (overall I need to take 28 pills, so that would be a week. My last dose would be on day 15).
Day 21:
Fells much better. Still some discomfort. I also got a rash from the antibiotics.
Day 60:
Pinching feeling once in several days, especially when going from a sitting to a standing position (car/chair).
Day 90:
After surgery checkup.
Blood Test:
Test Total - 394 ng/dL (was 347)
Test Free - 10.8 pg/ML (was 12)
Semen Analysis:
Sperm count: 80.5 (Million/ML)
Count/Ejaculate: 223.5 Million (> 40M is normal)
Motility: 72.5% (>50% is normal)
Rapid progressive Motility: 39% (>25% is normal)
So my semen analysis is prefect and was fixed after the surgery (at least something).
Strange, but my doctors said that Test Free is the most important parameter because this is what's available to the body compared to Test Total which is only 2% or so availability.
He offered my TRT, but said it would suggest to wait 3 more months, redo the blood work and comeback since it was only 3 months from the surgery and these things take time. He also mentioned that I had a varicocele level 1-2 (total of 7 veins were ligated on the right side only).
Small pinching every couple of weeks, but it gets way better. Doc advised to give it some time since it takes 6-12 months to heal completely.
Day 180:
Did my blood work again, this time I added by myself (tank you walk-in-lab) more parameters to check if my HPTA is screwed:
Test Total - 325 ng/dL (was 394)
Test Free - 12 pg/ML (was 10.8)
LH - 3.4
FSH - 4.1
Cortisol - 9.7
Prolactin - 9.5
Estradiol - 16.2
Progesterone - 0.3
Doc suggested 4 treatments:
1. Pellets - Lasts for 3-4 months. Constant test absorption. Negatives: semi-surgeical procedure that involves a scare. uncomfortable on the first 2-3 days (can sit/hurts while sitting). Absorption is not guarantee and the number of pellets is subjective to test absorption (can go up to 10-12 pellets). Highest costs from all solutions.
2. Androgel - Everyday application. Can't touch children/women after application for at least couple of hours. Sticks to t-shirts/shirts, and absorption is REALLY subjective. Skin rashes are common. Also very expensive.
3. Test Cypionate/Enanthate (100mg EW). Best option. Self application every week. Also an option to do one shot (200mg) every two weeks or so, depends how the body metabolize it. However, every week, or even twice a week, would keep T-levels constant (pretty much it's better to avoid spikes, since you will feel terrible).
4. HcG - was offered injections 3 X week, 1000IU/week to increase "natural test production" by LH. It feels like pain in the ass to inject it 3 times a week, but it's injected with an insulin needle, so it's not that bad. My testicles tells me to start TRT without going throughthe HcG route, but my brain tells me to be patient.
Doc suggested HcG since once going on TRT there is no way back basically, it's for life. HcG for several months can retain testicle mass and increase test production, depends how many Leydig cells (cells that produce test in the testicles) are there, and how much they are responsive to HcG (basically depends receptors at that area). I'm skeptical that HcG alone would help me, but I will try for three months and see what would happen. I will update as soon as I get my blood work done in about a month.
To sum up, Varicocelectomy surgery doesn't really help to increase T-levels. I did it because I had severe pain and my semen analysis was horrible. If you are doing it because you think it would raise your T-levels, just avoid it and go through the HcG and/or TRT route because these would help you for sure.
The surgery cost, including everything involved (I have the crappiest individual insurance from Blue Cross), was $2500.
