The results of the present study suggest, for the first time, that the management of bilateral, grade III, varicocele should include not only fertility and TT production but also the evaluation of PTH and Vitamin D. The long-term complications of bilateral varicocele may include, therefore, hypovitaminosis D and secondary hyperparathyroidism that, in turn, can affect bone mineralization, also in patients with no evidence of overt hypogonadism. Here, PTH is linked to secondary hyperparathyroidism.