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Urology/varicocele, prostate and testosterone

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QUESTION: I have a few questions about the connection between the three items in the title.

I have one big varicocele in the left. I have had it for over 15 years now and not had any pain but recently I noticed that it 'may' have got bigger.
I have read on wikipedia that these varicoceles can affect the prostate also. And that they cause bph.

In addition I have read that varicoceles, can lead to lower testosterone and perhaps permanent damages.  

All of this concerns me and confuses me. Some say varicoceles are best left alone if asymptomatic while other urologists recommend treatment, and cite the previously mentioned problems (eg low testosterone and prostate problems) to justify that recommendation.

http://www.ncbi.nlm.nih.gov/pubmed/3556625
This old paper from the 80's indicates that there is no connection between temperature and testosterone.

It is difficult to know what to believe and how to interpret the data.

What is your opinion?

ANSWER: Jim:

You asked for my opinion.  Asymptomatic varicoceles are best left alone unless there is some related problem.  It should not cause low testosterone or other permanent damage.  I cannot conceive of any scientific connection between varicoceles and prostate issues.  There is confirmed evidence only for possible infertility and discomfort, some evidence for smaller testicle size on that side only but this is problematic.  If there is no apparent problem, I tend to recommend that we leave them alone.

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

QUESTION: do they tend to get bigger like hernias as time goes on?
is it also possible that treatment is recommended simply to profit the people providing it, even if it is unnecessary?

Here is the wikipedia article I mentioned:
http://en.wikipedia.org/wiki/Varicocele

It says
Blood from the testes that cannot drain via the pampiniform plexus may route through the prostate in a process known as communicating vessels.[12] The increased flow of blood to the prostate can lead to congestion and enlargement of the gland (BPH) both through physical mechanisms and as a result of "accelerated prostate cell proliferation [growth] resulting from the extremely high concentration of free testosterone reaching directly from the testes to the prostate

True or false?

can you tell me a bit about testosterone and how it should be measured? From what i understand there are two kinds of testosterone and it fluctuates throughout the day. So how can it be accurately and meaningfully measured?

ANSWER: Jim:

While the rationale sounds plausible, I don't buy it.  The prostate does not grow just because it may get some additional blood.  If it did, the blood would be de-oxygenated and not much help and very low flow since it's venous blood and not the arterial blood full of nutrients and oxygen that would be needed for increased growth.  As far as a high level of free testosterone, this is speculative as there is no data so it's unproven.

In that event, we look at data.  We would expect to see patients with varicoceles requiring more treatment and/or surgery for prostate enlargement and that has never been demonstrated.

As far as testosterone levels, we typically look at peak morning levels since that is when the testosterone is usually highest.  In most labs, a level above 300 is ocnsidered normal.

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

QUESTION: It is interesting to know that testosterone peaks in the morning. My libido mostly peaks either late in the night or when i wake up. Is this related?

Also you did not tell me whether varicoceles get bigger. Do they? why do they grow and does that mean i might need treatment?

Can you also tell me if prostate problems can cause tenesmus like feelings?

Answer
Jim:

Varicoceles typically tend to enlarge but usually only very slowly or not at all.  Varicoceles grow because the problem that caused them is uncorrected without surgery.

Testosterone peaks and libido don't always match which is why libido is usually higher in the evenings while testosterone level peaks in the mornings.

Theroretically, prostate problems can cause all sorts of pelvic discomforts and disorders but tenesmus feelings would be unusual.

It would improper and unprofessional for a surgeon to recommend a surgery strictly for profit and not because there was a reasonable expected benefit to the patient.

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Stephen W. Leslie, MD

Expertise

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

Experience

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.

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

Publications
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.

Education/Credentials
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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