Lowered testosterone in male obesity: mechanisms, morbidity and management

With increasing modernization and urbanization of Asia, much of the future focus of the obesity epidemic will be in the Asian region. Low testosterone levels are frequently encountered in obese men who do not otherwise have a recognizable hypothalamic-pituitary-testicular (HPT) axis pathology. Moder...

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Bibliographic Details
Published in:Asian journal of andrology 2014-03, Vol.16 (2), p.223-231
Main Authors: Fui, Mark Ng Tang, Dupuis, Philippe, Grossmann, Mathis
Format: Article
Language:English
Subjects:
Androgens
androgens
hypogonadism
obesity
testosterone
weight loss
Evidence-Based Medicine
Hormone Replacement Therapy
Hormones
Humans
Invited Review
Male
Men
Obesity
Obesity - blood
Testosterone
Testosterone - administration & dosage
Testosterone - blood
Testosterone - therapeutic use
Weight control
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Summary:With increasing modernization and urbanization of Asia, much of the future focus of the obesity epidemic will be in the Asian region. Low testosterone levels are frequently encountered in obese men who do not otherwise have a recognizable hypothalamic-pituitary-testicular (HPT) axis pathology. Moderate obesity predominantly decreases total testosterone due to insulin resistance-associated reductions in sex hormone binding globulin. More severe obesity is additionally associated with reductions in free testosterone levels due to suppression of the HPT axis. Low testosterone by itself leads to increasing adiposity, creating a self-perpetuating cycle of metabolic complications. Obesity-associated hypotestosteronemia is a functional, non-permanent state, which can be reversible, but this requires substantial weight loss. While testosterone treatment can lead to moderate reductions in fat mass, obesity by itself, in the absence of symptomatic androgen defi ciency, is not an established indication for testosterone therapy. Testosterone therapy may lead to a worsening of untreated sleep apnea and compromise fertility. Whether testosterone therapy augments diet- and exercise-induced weight loss requires evaluation in adequately designed randomized controlled clinical trials.
ISSN:1008-682X
1745-7262
DOI:10.4103/1008-682X.122365