<p>Varicocele is a vascular condition that can significantly impair fertility and testicular endocrine function through multiple, yet not fully understood, pathophysiological mechanisms. Among these, oxidative stress plays a central role, contributing to the disruption of both spermatogenesis and steroidogenesis. This complexity necessitates the involvement of the endocrinologist within the framework of an integrated clinical approach. In both paediatric and adult patients, the management of varicocele requires a multidisciplinary strategy, based on the use of reliable predictive markers and personalised therapeutic strategies, aimed at safeguarding the patient’s reproductive and hormonal health.</p>