Short answer: The most common varicocele symptoms are a dull ache in the scrotum that gets worse when standing and eases when lying down, a lump that can feel like a “bag of worms” above the testicle (usually on the left), a smaller testicle on the affected side, and trouble conceiving. Many varicoceles cause no symptoms at all. Larger varicoceles are linked with lower testosterone in some men, and studies show surgical repair raises total testosterone on average, mostly in men whose levels were low to begin with. Whether repair makes sense for you is a decision to make with a urologist after an exam, an ultrasound and morning blood work.
Key Takeaways
- A varicocele is an enlargement of the veins in the scrotum, similar to a varicose vein in the leg. Cleveland Clinic estimates it affects 15% to 20% of men in the United States.[1]
- Typical varicocele symptoms are a dull, dragging ache, a soft lump above the testicle, testicle shrinkage and infertility, but many men have none.[1][2]
- Larger varicoceles may raise the risk of low testosterone (hypogonadism), though not every man with a varicocele has low levels.[1][4]
- A 2024 meta-analysis of 48 studies found total testosterone rose by about 82 ng/dL after varicocele repair compared with before surgery.[6]
- Repair options include microsurgical or laparoscopic varicocelectomy and non-surgical embolization. Each has its own recovery time and risks.[3]
- No supplement treats a varicocele or the hormone changes linked to it. See a urologist for diagnosis and decisions.
What Is a Varicocele?
A varicocele is a cluster of widened veins inside the scrotum. These veins belong to the pampiniform plexus, the network that drains blood away from each testicle. When the one-way valves in those veins do not work properly, blood pools and the veins stretch, much like varicose veins in the legs.[1][2]
Most varicoceles form on the left side. Mayo Clinic explains that the path of the left testicular vein makes blood flow problems more likely there.[2] Right sided and two sided varicoceles are less common, and Mayo notes that ultrasound can help rule out something blocking blood flow, which is one reason a new or unusual varicocele should always be examined.[3]
The exact cause is unknown, and no significant risk factors have been identified.[2] Many varicoceles are thought to be present from birth and are often first noticed in the teen years, around puberty.[1]
Varicocele Symptoms: What Men Actually Notice
Most men with a varicocele never feel it. It is often found during a routine physical, a fertility workup or an ultrasound done for another reason. When varicocele symptoms do show up, they usually look like this:[1][2]
- Dull, aching pain. A heavy or dragging feeling in the scrotum that is worse after standing for a long time or late in the day, and that often eases when you lie down.
- A lump above the testicle. A large varicocele can feel like a “bag of worms.” Smaller ones may only be felt, not seen.
- Uneven testicle size. The testicle on the affected side may be noticeably smaller (atrophy).
- Swelling of the scrotum or testicle.
- Trouble conceiving. Infertility is defined as no pregnancy after at least a year of trying.
Pain, swelling or a new mass in the scrotum can come from several conditions, so these signs call for an exam rather than self diagnosis.[2]
Varicocele grades
Doctors grade a varicocele by how easy it is to feel and see. The Valsalva maneuver means taking a deep breath, holding it and bearing down, which makes the veins easier to examine.[1][3]
| Grade | What the doctor finds | What it usually means |
|---|---|---|
| Grade 0 (subclinical) | Not felt on exam, seen only on ultrasound | Smallest, usually no symptoms |
| Grade I | Not visible, felt only during Valsalva | Small |
| Grade II | Felt without Valsalva, not visible | Moderate |
| Grade III | Clearly visible and easy to feel | Largest, most likely to be linked with symptoms |
Grade matters because Cleveland Clinic notes that larger varicoceles may increase the risk of low testosterone, and that untreated higher grade varicoceles can permanently damage the testicles.[1]
Can a Varicocele Cause Low Testosterone?
It can contribute in some men, but the link is not universal. Here is what the human research shows, kept separate from animal work.
Why a varicocele may affect hormones
Testosterone is made by Leydig cells inside the testicle. Pooled blood around the testicle is thought to interfere with normal temperature control, which may lead to oxidative stress and a buildup of waste products in testicular tissue.[2] Researchers describe this as a “pantesticular” insult, meaning it can affect both sperm production and hormone production.[4] In animal models, testosterone declined after a varicocele was created and only partly recovered after repair.[5] Animal varicoceles are created suddenly by surgery, so those results may not translate directly to men.[4]
What human studies show
In several older studies comparing men with and without a varicocele, average testosterone was lower in the varicocele groups, though results varied between studies.[4] A 2022 review with meta-analysis in Endocrines concluded that the connection between varicocele and hypogonadism is becoming clearer, but that it is still not certain whether men with a varicocele face a higher risk of clinical low testosterone symptoms.[4]
Low testosterone itself can cause testicle shrinkage, lower sex drive, loss of muscle mass and depressed mood.[1] These overlap with sleep problems, weight gain, stress and many medications, which is why lab testing matters. Our guide to the signs of low testosterone covers the full list.
What happens to testosterone after repair
| Study | Design | Key testosterone finding |
|---|---|---|
| Cannarella et al., World Journal of Men’s Health (2024)[6] | Systematic review and meta-analysis, 48 studies | Total testosterone rose about 82 ng/dL versus before repair and about 92 ng/dL versus unrepaired men. After repair, levels did not differ from healthy men. |
| Whelan and Levine, Translational Andrology and Urology (2016)[5] | Review of 28 human studies | 15 of 28 studies reported higher testosterone after repair, usually at 6 to 12 months. Gains were concentrated in men with low or low normal baseline levels. |
| Meta-analysis cited by Whelan and Levine[5] | 9 studies, 814 men | Mean increase of 97.48 ng/dL after surgical repair. |
| Rodriguez et al., cited by Whelan and Levine[5] | 202 men without infertility, baseline 648 ng/dL | Rise to 709 ng/dL, not statistically significant. |
Two patterns stand out. First, men who start low tend to gain the most: in one study cited by Whelan and Levine, men starting under 300 ng/dL rose from 219.3 to 358.1 ng/dL six months after repair.[5] Ten of the 13 studies that showed no improvement had average baseline levels above 450 ng/dL.[5] Second, most of the data come from men being evaluated for infertility, so results may not apply to every man.[5]
Whelan and Levine also note that “there is little data examining varicocele repair for the sole purpose of treating low testosterone,” and that it is unclear whether repair prevents a future decline.[5] The 2022 review flagged mostly retrospective, small studies with short follow up.[4] In short, the evidence supports discussing repair with a urologist when low testosterone and a clinical varicocele occur together, not assuming surgery will fix every symptom.
Varicocele and Fertility
Fertility is the most common reason men are referred for varicocele treatment. Mayo Clinic reports that about 10% to 20% of men diagnosed with a varicocele have difficulty fathering a child, and about 40% of men with fertility problems have one.[2] Whelan and Levine cite rates of up to 35% in men with primary infertility and up to 80% in men with secondary infertility (trouble conceiving after a previous pregnancy).[5] Many men with a varicocele still father children without any treatment.[1]
How Doctors Diagnose a Varicocele
A urologist will usually:
- Take a history of pain, swelling, fertility goals and symptoms of low testosterone.
- Examine the scrotum lying down and standing, including the Valsalva maneuver.[3]
- Order a scrotal ultrasound to confirm the diagnosis, measure the veins and rule out other causes.[1][3]
- Request a semen analysis if fertility is a concern.[1]
- Check hormones such as testosterone and FSH.[1]
Testosterone follows a daily rhythm and is usually tested in the morning, so timing your blood draw matters. See the best time to check testosterone levels and how to read normal testosterone levels before your appointment.
Varicocele Treatment Options
A varicocele often needs no treatment. Mayo Clinic lists infertility, delayed testicle development in teens, abnormal semen results in adults and chronic pain not controlled by medication as common reasons to consider repair.[3] In the 2024 meta-analysis, the authors suggest their findings may help guide treatment decisions for men with low testosterone or a steady decline in testosterone.[6]
| Option | How it works | Typical recovery |
|---|---|---|
| Conservative care | Supportive underwear or an athletic supporter, cold packs (no more than 15 minutes at a time), over the counter pain relievers after checking with a doctor | None needed, for small or painless varicoceles[1][3] |
| Microsurgical varicocelectomy | Small incision low in the groin; surgeon ties off veins under a microscope, about 2 to 3 hours, outpatient | Most return to work in about 1 week and exercise in about 2 weeks[3] |
| Laparoscopic varicocelectomy | A few small incisions in the lower abdomen with a camera, about 30 to 40 minutes, outpatient | Similar to microsurgery[3] |
| Embolization | A radiologist threads a thin tube through a vein in the groin or neck and blocks the testicular veins with coils or a scarring solution, about 1 hour | Most return to work in 1 to 2 days and exercise after about 1 week[3] |
Surgical risks include fluid around the testicle (hydrocele), recurrence, infection, artery damage, chronic testicular pain and a blood collection (hematoma).[3] When surgery is done mainly for pain, Mayo notes the pain may worsen or change, so the balance of benefit and risk is different.[3] For testosterone specifically, Whelan and Levine found that results after embolization were inconsistent, while microsurgical repair was described as a valid option for appropriately counseled men with low testosterone and a varicocele.[5]
When to See a Urologist
- You feel a new lump, swelling or pain in the scrotum.
- One testicle has become noticeably smaller.
- You and your partner have not conceived after a year of trying.
- Blood work shows low testosterone and you have a known varicocele.
- A varicocele appears suddenly or looks unusual. Ultrasound can rule out other causes, including something blocking blood flow.[3]
A Note on Supplements
No herbal product or vitamin shrinks a varicocele or replaces an evaluation by a urologist. If you already take any supplement, including a botanical formula such as Ultra Bann, bring the bottle or the full label to your appointment so your urologist can review it alongside your lab work and any planned procedure. Ultra Bann lists every ingredient and amount on its label, which you can view on the Ultra Bann ingredients page. For general guidance on checking a product, see our supplement safety guide.
Frequently Asked Questions
What are the first signs of a varicocele?
Often there are none. When signs appear, the first ones are usually a dull ache or heaviness in the scrotum after standing, which eases when lying down, or a soft lump above the left testicle that feels like a “bag of worms.”[2]
Can a varicocele cause low testosterone?
It can contribute, particularly with larger varicoceles, but many men with a varicocele have normal levels.[1][4] Only a morning blood test can tell you where you stand.
Will varicocele surgery raise my testosterone?
On average, studies show total testosterone rises after repair, with the largest gains in men whose levels were low before surgery.[5][6] Men with normal baseline levels often see little change.[5] Your urologist can tell you whether you are likely to benefit.
Can a varicocele go away on its own?
Do not count on it, but most varicoceles cause no problems and need only monitoring. Small, painless varicoceles that do not affect fertility often need no treatment.[1]
Is a varicocele dangerous?
A varicocele is not life threatening.[1] The main concerns are pain, testicle shrinkage, reduced fertility and, in some men, lower testosterone. A new scrotal mass should still be examined to rule out other conditions.[2]
References
- Cleveland Clinic. Varicoceles. my.clevelandclinic.org
- Mayo Clinic. Varicocele: Symptoms and causes. mayoclinic.org
- Mayo Clinic. Varicocele: Diagnosis and treatment. mayoclinic.org
- Russo GI, Asmundo MG, Perelli S, et al. Relationship between Varicocele and Male Hypogonadism: A Review with Meta-Analysis. Endocrines. 2022;3(1):100-106. mdpi.com
- Whelan P, Levine L. Effects of varicocelectomy on serum testosterone. Translational Andrology and Urology. 2016;5(6):866-876. tau.amegroups.org
- Cannarella R, Shah R, Ko E, et al. Effects of Varicocele Repair on Testicular Endocrine Function: A Systematic Review and Meta-Analysis. World Journal of Men’s Health. 43(4):818-843. PMID 39434394. pubmed.ncbi.nlm.nih.gov
These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease. This article is for information only and is not medical advice.
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