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Urology/Low Testosterone


QUESTION: I have read recently from the NY Presbyterian hospital research, that it is now believed that a non reducible vacrocelle can cause low testosterone in men. I have recently been diagnosed and the ultra sound proves it that I have this condition as well as an epididymis cyst. Also, my blood work for testosterone shows I'm low normal ranges of T. I have noticed long before the diagnosis that my interest in sex decreased, but not my desire.  I use Viagra and it seems to work fine.  However, I'd much rather have my T return to normal production in order to avoid taking the pills.  Sex with my wife would be more spontaneous, than planned.
Do you think this report could be correct?  In it states that the increase in T was on average 178ng/dl over those that did not have the surgery.


You are correct.  There are actually 3 studies suggesting a significant increase in testosterone production after varicocele repairs.  However, many of the patients in the study you mention did not have clinically low testosterone levels to start with so it's unclear how much of an improvement you may see and it's unclear if low testosterone is the cause of your problem anyway.  

My advice?  You could try a 3-6 month course of testosterone supplementation just to see if normal testosterone levels correct your problem.  If so, then the surgery might be of some benefit but it's a gamble.  If normalizing testosterone doesn't help, then don't do the surgery unless there is another good reason to do so.

Talk to your local urologist about this issue.  And thanks for asking a good question.

---------- FOLLOW-UP ----------

QUESTION: Thanks for getting back so fast.  And not asking for a credit card for me to get the info.  I wouldn't have done it, but thanks for being here.

When your T is low, or even low normal, shouldn't sex binding hemoglobin be also measured to assure both are in concert?  I've also read that low t and even "normal" low T can be further affected by a higher (I think) than normal Sex Binding hemoglobin?  Is this the case.  How is this treated, if at all?


Its actually sex binding globulin (not hemoglobin) which is a protein made in the liver.  It's function is to bind circulating testosterone.  It is not usually measured routinely although it can be useful in some situations.  Most of the time, total testosterone and free testosterone are enough to begin evaluations.  If a further examination is needed, you may have to see an endocrinologist.


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Stephen W. Leslie, MD


Questions concerning erectile dysfunction, kidney stones and prostate disorders including prostate cancer. I have a special interest in kidney stone disease prevention.


Full time practicing urologist with 30 years experience. Associate Professor of Surgery and Chief of Urology at Creighton University Medical Center. Editor in Chief of eMedicine Urology internet textbook. Author of only NIH approved book written for patients by a urologist on the subject of kidney stones "The Kidney Stones Handbook". Inventor of the "Parachute" and "Escape" kidney stone baskets and the "Calculus" stone prevention analysis computer program.

American Urological Association, Ohio State Medical Association, Sexual Medicine Society

Men's Health, Journal of Urology, Urology, Healthwatch Magazine, Emergency Medicine Monthly, eMedicine, "The Kidney Stones Handbook", and numerous articles in various newspapers. He is also the editor of the Urology Board Review by McGraw-Hill used by urologists to study for their Board Certification Examinations.

Graduate of New York Medical College with residencies completed at Metropolitan Hospital New York, Albany Medical Center and University of Wisconsin-Madison.

Awards and Honors
Thirlby Award of the American Urological Association. Rated as one the country's Best Urologists by the Independent Consumer's Research Institute

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