I recently had a varicocele fixed and I thought I would post some observations on the process that might be useful for anyone else with a similar issue.
- Find a specialist who is pre-disposed to treat what you think you may have. I see a lot of people say “my endo won’t treat this” or “my uro won’t treat that”. Don’t bother with someone who doesn’t specialize in treating your overall issue. Try to find a holistically focused doctor or clinic who treats reproductive issues. This will mean that they combine several disciplines like endocrinology and surgery, and also that the focus on an end goal like fertility or reproductive health.
- Recognize that most clinics either do embolization or microsurgery for varicoceles, so you may want to research and pick one or the other beforehand if you have a strong preference. I picked based on likely fit with the doctor and because her web-site actually mentioned both so I thought I would get a somewhat fair assessment between the two options. Unfortunately, a lot of medicine revolves around selling procedures (people with a hammer looking for a nail) rather than objective unbiased guidance around a solution.
- Regarding embolization or surgery, here is a quick summary:
o For a left side varicocele either method should be fine
o For varicoceles on the right side or one both sides, there may be an advantage to surgery. The advantage would be that it is more likely to work the first time.
o Here is a link to the main study on this topic: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3433543/
o The other disadvantage to embolization that I was able to find was the risk of the coil moving in the body, however my doctor thought inflammation from the coil was a bigger risk, but I did not research that since I had already decided to go with the surgery approach because I wanted to maintain a relationship with a doc I felt comfortable with, not because of some advantage of MS. I think this is important long-term since while prostate issues and TRT are not an issue for me right now, it would be key to have access to someone who is fairy forward-thinking if they become an issue in the future (hopefully as far in the future as possible.) The biggest risk of surgery that I know if is hitting an artery, however that is why you want a micro-surgeon who specializes in this type of thing.
o One of the problems with picking embolization in advance is that you won’t necessarily know the complete nature of the varicocele is until you have ultrasound on it.
o A lot of the embolization places seem to just be radiologists for hire and do not have a comprehensive reproductive practice, so it is best if you can find a clinic that will offer both or give you a referral
o The list of post-surgery restrictions seemed daunting and surgery will be more of a recovery challenge than embolization (Surgery cuts the abdominal wall so you are supposed to be fairly immobile for a couple of weeks), but for anyone used to dealing with contact sport injuries, it won’t be too much of an issue. I came home after the surgery, rested for a few hours and then did some gardening, so it is not a big deal if you are in ok shape, but heavy squats and deadlifts are out for 3-4 weeks.
o Surgery will require antibiotics for a few days. I’m not sure if embolization does, but if it did not, that would be another advantage.
- If you’re trying to check yourself for a possible varicocele, you have to check in the evening as it will likely not be prominent in the morning. Also, just because you can’t feel anything doesn’t mean you don’t have a small one that would be detected by ultrasound, so it is worth an exam at someplace that specializes in fertility if you think you may have a hormonal issue.
- If you have to travel to find a good doctor, travel. You want someone who does a lot of what you’re having done, and that generally means big-city hospitals. Doctors who do varicocele surgery are likely also doing a lot of vasectomy reversals, so again, fertility clinics are a good place to look.
- From what I can tell, fertility clinics seem like a good place to find TRT-related help as well since they seem to deal with closely related issues such as HCG, clomid, etc.
- I would stay completely away from general doctors on any hormone related issue from what I have seen. They are into minimalist medicine (if you don’t die before you can pay the bill then you’re ok) vs. discretionary medicine. The one I had contact with on this journey said “we don’t treat varicoceles if there are no symptoms” .,.one of the more idiotic statements I’ve heard. Kind of like George Carlin’s “saliva causes cancer but only when swallowed in small amounts over a long period of time” line.
- As far as benefits, I would say they are good but not transformational so far. My hormone levels feel a little better although they were not bad before (I have not done a blood test yet), however I think getting a varicocele fixed is a must if at all possible, since it can only get worse, and any other intervention could be limited by it. Interestingly, a strong itching sensation I had previously vanished immediately after it was fixed. I also think Sam’s body temperature regulation theory has a lot of merit.