Varicocele, Hormones and Other Medical Causes of Male Infertility

Male fertility is not only about timing, stress, or “trying harder”. In many couples, a medical factor affects sperm production, sperm movement, hormone signalling, or the path sperm takes out of the body.

This article explains varicocele and other medical causes of male infertility in a clear, practical way. It is written for education only and is not a substitute for diagnosis or treatment by a urologist, andrologist, or fertility specialist.

Why medical assessment matters

Infertility is generally considered when a couple has not conceived after regular unprotected intercourse for 12 months, or earlier when there are known concerns such as irregular periods, older reproductive age, previous surgery, or abnormal semen results.

For men, the first clue often comes from a semen analysis. This test looks at features such as sperm count, movement, and shape. It is useful, but it does not explain everything on its own.

A proper assessment may include:

• A medical and sexual history

• A physical examination of the testes, scrotum, and reproductive tract

• One or more semen analyses, usually repeated if abnormal

• Hormone blood tests when indicated

• Ultrasound or other imaging in selected cases

• Genetic tests in specific severe sperm abnormalities

  
  

Lifestyle advice has a place, especially around smoking, alcohol, heat exposure, sleep, weight, and exercise. But lifestyle advice is not the same as diagnosis. A man with a varicocele, obstruction, low testosterone signalling, or testicular injury may need targeted medical review.

Varicocele is a common and treatable finding

A varicocele is an enlargement of veins in the scrotum, commonly described as feeling like a “bag of worms” during examination. It is more often found on the left side because of how the veins drain, though it can occur on both sides.

Varicoceles may affect fertility by raising scrotal temperature, increasing oxidative stress, and affecting how the testicle functions. Some men have discomfort or a dragging sensation. Others have no symptoms and only discover it during fertility testing.

A urologist may assess:

• Whether the varicocele is felt on examination

• Testicular size and consistency

• Semen analysis results

• Pain or discomfort

• The couple’s overall fertility situation

  
  

Not every varicocele needs treatment. Some are small and not clearly linked to the fertility issue. When treatment is suitable, options may include microsurgical repair or radiological procedures. The decision should be made with a specialist who can balance benefits, risks, semen results, and the couple’s plans.

Obstruction can block sperm even when production is normal

Some men produce sperm normally, but sperm cannot travel out properly. This is called obstructive azoospermia when no sperm appear in the semen because of a blockage.

Possible causes include:

• Previous vasectomy

• Infection or inflammation affecting the reproductive tract

• Scarring after surgery

• Congenital absence of parts of the vas deferens

• Ejaculatory duct obstruction

  
  

This is one reason why semen analysis and examination answer different questions. A semen analysis may show no sperm, but it cannot always tell whether the cause is poor production or a blockage. A specialist may need to review testicular size, hormone results, semen volume, pH, imaging, and sometimes genetic testing.

Treatment depends on the cause. In some cases, surgical reconstruction may be discussed. In others, sperm retrieval with assisted reproduction may be more suitable.

Hormonal disorders can reduce sperm production

Sperm production relies on signals between the brain and the testes. The hypothalamus and pituitary gland send hormonal messages that help regulate testosterone and sperm production.

Hormonal causes of male infertility may involve:

• Low signals from the pituitary gland

• High prolactin levels

• Thyroid disorders

• Testosterone deficiency from testicular or brain-related causes

• Medical conditions affecting the endocrine system

  
  

Symptoms can vary. Some men notice low libido, erectile changes, fatigue, reduced shaving frequency, breast tenderness, or loss of muscle mass. Others feel well even with abnormal blood tests.

Hormone treatment should be handled carefully. Testosterone replacement, for example, can improve symptoms in some men but may reduce or stop sperm production. Men who are trying to conceive should tell their doctor before starting any hormonal medication.

Testicular factors affect the sperm factory itself

The testes are where sperm are made. When testicular tissue is damaged or underdeveloped, sperm numbers may fall, movement may be poor, or sperm may be absent from the semen.

Possible testicular factors include:

• Undescended testes in childhood

• Previous testicular torsion

• Mumps orchitis after puberty

• Testicular injury

• Chemotherapy or radiotherapy

• Genetic conditions

• Severe long-term heat exposure

  
  

A smaller testicular size or soft consistency on examination may suggest reduced sperm production. Hormone tests can also help show whether the testicles are receiving signals but not responding well.

A urologist or fertility specialist can determine whether further tests or procedures are needed. One person may need repeat semen testing and monitoring; another may need genetic review, sperm retrieval discussion or assisted reproduction planning.

Medicines, anabolic steroids, and supplements can play a role

Some prescribed medicines may affect libido, ejaculation, hormones, or sperm production. Examples may include certain treatments for high blood pressure, depression, infections, prostate conditions, pain, or cancer. The effect varies by medicine and by individual.

Anabolic steroids are a major concern. They can suppress the body’s own fertility hormones, causing the testes to reduce sperm production. Some men develop very low sperm counts or azoospermia after using gym-related steroid cycles or testosterone products.

Do not stop prescribed medication on your own. If a medicine may be affecting fertility, discuss it with the prescribing doctor. There may be safer alternatives, dose adjustments, or a planned approach that protects your overall health.

Be cautious with “testosterone boosters”, bodybuilding injections, and fertility supplements bought without medical advice. Products may contain undeclared hormones or substances that interfere with treatment.

TCM assessment and individual care

At Olive3, a TCM consultation considers your fertility history, symptoms, constitution, sleep and digestion. Depending on the assessed pattern, your physician may discuss supporting Kidney Qi (a traditional functional concept) or moving Qi and Blood (traditional concepts of functional activity and nourishment). These terms explain the TCM approach to individual care.

Physician Koh discusses suitable options such as acupuncture, individually prescribed Chinese medicine and daily routines, with clear treatment goals and review points. Bring previous reports so your plan can take account of any structural or hormonal findings.

Structural and hormonal concerns are assessed through examination and relevant investigations. Abnormal semen results, pain or testicular changes warrant timely review by a urologist or fertility specialist. Your TCM appointments can be coordinated with that assessment.

If you are taking prescribed medicines, undergoing IVF or IUI, or planning surgery, tell both your doctor and TCM physician. This helps reduce the risk of interactions and keeps care coordinated.

Short FAQ

Can a varicocele always be felt?

Not always. Larger varicoceles may be felt during examination, especially when standing. Smaller ones may only be seen on ultrasound. A specialist will decide whether the finding is clinically relevant.

Is one semen analysis enough?

Usually, an abnormal result is repeated because sperm results can vary with fever, stress, timing, illness, and collection factors. Your doctor will advise the timing.

Can lifestyle changes fix male infertility?

Healthy habits can support fertility, but they may not correct medical causes such as obstruction, significant varicocele, hormonal disease, or testicular damage.

Should I take testosterone if my level is low?

Do not start testosterone if you are trying for a baby without fertility-focused medical advice. Testosterone therapy can suppress sperm production.

Practical next steps in Singapore

If pregnancy has not happened after a reasonable period of trying, or if a semen analysis is abnormal, arrange a review with a urologist or fertility specialist. Bring previous semen reports, blood tests, surgery history, medication lists, and any information about anabolic steroid or testosterone use.

A practical sequence may look like this:

1. Book a semen analysis at a recognised laboratory.

2. See a urologist or fertility specialist for examination and interpretation.

3. Complete hormone, imaging, or genetic tests if recommended.

4. Discuss whether treatment, monitoring, assisted reproduction, or coordinated care is suitable.

5. If using TCM, keep it coordinated with your medical care.

   
   

Related care: TCM male fertility support in Singapore

Reviewed and approved by Physician Koh Soo Hoon, September 2026.

Sources

• WHO Infertility fact sheet: https://www.who.int/news-room/fact-sheets/detail/infertility

• AUA/ASRM male infertility guideline: https://integration.asrm.org/practice-guidance/practice-committee-documents/diagnosis-and-treatment-of-infertility-in-men-aua-asrm-guideline-part2/

  
  
  
  

TCM terminology reference: WHO international standard terminologies on traditional Chinese medicine. Reference for the traditional TCM terms used in this article.

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