Objective: To compare the clinical effects of microscopic low ligation and laparoscopic high ligation in the treatment of varicocele in young men. Methods: A total of 82 young men diagnosed with varicocele in our hospital from October 2022 to May 2025 were selected and divided into groups (41 cases/group) by random number table method. The control group received laparoscopic high ligation treatment, while the observation group received microscopic low ligation treatment. The basic surgical indicators, postoperative pain, semen quality, peripheral blood hormones [total testosterone (T), follicle-stimulating hormone (FSH), luteinizing hormone (LH), and prolactin (PRL)], and surgical safety were compared between the two groups. Results: The operation time of the observation group was longer than that of the control group, but the intraoperative blood loss, postoperative feeding time, and hospital stay of the observation group were all shorter than those of the control group (P < 0.05). The pain degree of the observation group 3 days after the operation was less than that of the control group (P < 0.05). After the operation, the semen quality (sperm concentration, total sperm count, total sperm motility, and normal morphology rate) of both groups improved compared with before, and the semen quality of the observation group was higher than that of the control group (P < 0.05). After the operation, the peripheral blood hormone levels (T, FSH, LH, and PRL) of both groups decreased compared with before, and the values of these four peripheral blood hormones in the observation group were lower than those in the control group (P < 0.05). The proportion of patients with complications in the observation group was 4.88% (2/41), which was lower than 19.51% (8/41) in the control group (P < 0.05). Conclusion: Compared with laparoscopic high ligation, microscopic low ligation for varicocele in young men is relatively time-consuming, but it can reduce intraoperative blood loss, postoperative feeding time, and hospital stay, alleviate postoperative pain, improve postoperative semen quality and peripheral blood hormone levels, and enhance the prevention and control of surgical complications.