**3. Hormonal studies**

Hormone profile studies may be beneficial in the workup of a varicocele in pediatric and adolescent male patients, as is the case with the adult population. The presence of varicocele has been associated with higher serum levels of basal follicle-stimulating hormone (bFSH) and basal luteinizing hormone (bLH) in patients with pathologic semen analysis with lower inhibin B levels.

On the other hand, Romeo and colleagues found that inhibin B was decreased but all other hormones (LH, FSH, testosterone) were normal and there was no correlation with semen parameters [14]. There is currently no consensus on the utilization of hormone profile laboratory values in the workup of this population [15–17].

Another important factor is represented by sperm nuclear DNA fragmentation, which occurs in adolescent varicocele even when there are no changes in sperm quality as assessed by conventional seminal analysis. Bertolla et al. found the presence of DNA sperm fragmentation in adolescent varicocele even in the presence of normal sperm [18].

This is probably due to both increased oxidative stress and temperature. DNA sperm fragmentation could become an essential additional diagnostic test to be recommended for patients with clinical varicocele [19, 20].
