Urology, Men's Health, Hormonal Health
9/16/2026You feel a dull, heavy ache in your left testicle at the end of a long day. Or you notice a tangle of veins above the testicle, like a bag of worms. Or you feel nothing at all, and a fertility test flagged a problem. All three paths lead to the same place. A varicocele.
Veins in your spermatic cord carry blood away from each testicle, heading back toward the heart. One-way valves keep the blood moving upward. When a valve fails, blood pools in the veins below it, and gravity does the rest. The veins stretch and swell into the tangle you feel or see.
The left side fails far more often because its vein drains at a sharper angle. A right-sided varicocele, or a sudden new one, deserves extra attention, since it sometimes signals an abdominal mass pressing on a vein.
Urologists grade varicoceles by feel and sight.
| Grade | Finding |
|---|---|
| Grade 1 | Felt only when you bear down, like pushing to pass stool |
| Grade 2 | Felt while standing, not visible |
| Grade 3 | Visible through the scrotal skin, the classic bag of worms |
Higher grades tend to cause more problems, though even a small varicocele hurts sperm counts in some men.
Your testicles run cool on purpose, a few degrees below core body temperature. This cool environment is what sperm and testosterone production need. Pooled blood from a varicocele raises scrotal temperature and stresses the tissue, including the Leydig cells, which produce testosterone.
The research supports both links. Men with varicoceles average lower sperm counts and lower testosterone than men without them, and repair raises both. One meta-analysis found varicocelectomy lifts testosterone by a modest but real amount, most clearly in men starting at the low end. For fertility, studies show surgical repair improves semen parameters and increases pregnancy rates for couples where the man has a clinical varicocele and abnormal semen.
Observation is a legitimate choice. Many men live with a varicocele for decades without trouble, and repair does not guarantee better numbers. You should talk to a urologist about treatment if you have pain, an atrophied (smaller) testicle, a low sperm count with fertility plans, or low testosterone with symptoms.
| Option | What happens | Recovery |
|---|---|---|
| Observation | Annual checks, treat symptoms if they appear | None |
| Microsurgical varicocelectomy | Veins tied off under a microscope, outpatient | A few days of rest, weeks of light activity |
| Radiological embolization | A catheter blocks the faulty veins, no incision | Usually 1 to 2 days |
Both procedures work well. Microsurgery carries the lowest recurrence rate, and embolization avoids the incision entirely. Your urologist matches the option to your anatomy.
Sudden, severe, one-sided testicular pain is not a varicocele. It signals testicular torsion, a surgical emergency, and you go to the emergency room immediately, not the clinic next week. A lump is also not a varicocele. It needs a scrotal ultrasound to rule out cancer. And a varicocele diagnosis made over the internet is not a diagnosis. Feel something odd, get the ultrasound, and let the images settle it.
For the day-to-day habits supporting healthy testosterone, see our guide to raising testosterone naturally.
A varicocele is a common plumbing problem, present in one in seven men, and it explains a share of low sperm counts and low testosterone. Most men never need surgery. If you have pain, a smaller testicle, fertility plans, or symptoms of low T, see a urologist, confirm the diagnosis with an ultrasound, and weigh the options with real numbers. The fix is routine, and the evidence behind it is solid.