Varicocele is defined as an excessive dilation of the pampiniform plexus. The association between varicocele and infertility has been well-established as evidenced by negative effects on spermatogenesis. Accumulating evidence now suggests that varicocele presents a pantesticular insult, with resultant impairment of Leydig cell function. The presence of a varicocele has been linked to lower serum testosterone levels and varicocelectomy may reverse some of the adverse effects on androgen production. In this review, the evidence linking varicoceles to impaired steroidogenesis and which cohorts of men may benefit most from varicocele repair are discussed.