Body weight loss reverts obesity-associated hypogonadotropic hypogonadism: a systematic review and meta-analysis

Abstract

Objective: Few randomized clinical studies have evaluated the impact of diet and physical activity on testosterone levels in obese men with conflicting results. Conversely, studies on bariatric surgery in men generally have shown an increase in testosterone levels. The aim of this study is to perform a systematic review and meta-analysis of available trials on the effect of body weight loss on sex hormones levels. Design: Meta-analysis. Methods: An extensive Medline search was performed including the following words: 'testosterone', 'diet', 'weight loss', 'bariatric surgery', and 'males'. The search was restricted to data from January 1, 1969 up to August 31, 2012. Results: Out of 266 retrieved articles, 24 were included in the study. Of the latter, 22 evaluated the effect of diet or bariatric surgery, whereas two compared diet and bariatric surgery. Overall, both a lowcalorie diet and bariatric surgery are associated with a significant (P!0.0001) increase in plasma sex hormone-binding globulin-bound and -unbound testosterone levels (total testosterone (TT)), with bariatric surgery being more effective in comparison with the low-calorie diet (TT increase: 8.73 (6.51-10.95) vs 2.87 (1.68-4.07) for bariatric surgery and the low-calorie diet, respectively; both P!0.0001 vs baseline). Androgen rise is greater in those patients who lose more weight as well as in younger, non-diabetic subjects with a greater degree of obesity. Body weight loss is also associated with a decrease in estradiol and an increase in gonadotropins levels. Multiple regression analysis shows that the degree of body weight loss is the best determinant of TT rise (BZ2.50G0.98, PZ0.029). Conclusions: These data show that weight loss is associated with an increase in both bound and unbound testosterone levels. The normalization of sex hormones induced by body weight loss is a possible mechanism contributing to the beneficial effects of surgery in morbid obesity.

Hypogonadism as an additional indication for bariatric surgery in male morbid obesity?

“…Bariatric surgery has been extensively described to ameliorate sex hormone and SHBG levels in morbidly obese patients (9,14,15,16,17,18,19), with an effect that may exceed what is predictable on the basis of weight loss (17). In this study, we demonstrate that the increase in androgens (cFT and TT) occurs only in hypogonadal patients (TT!8 nmol/l).…”

“…The previous works reported that BMI (9,17) and age (18) were among the best predictors of androgen recovery after bariatric surgery. However, such cohorts of morbidly obese patients included both hypogonadal and eugonadal subjects.…”

Testosterone and glucose metabolism in men: current concepts and controversies

“…It has been estimated thatMore markedly (O30%), body weight loss secondary to bariatric surgery can raise testosterone by O10 nmol/l (Grossmann 2011). This has been confirmed by a recent systematic review and meta-analysis of studies that have reported the effects of weight loss on testosterone levels (Corona et al 2013b). Non-surgical weight loss achieved a mean weight reduction (9.8%) in body weight.…”

Bariatrik Cerrahi Cinselliği Etkiler Mi? Sistematik Derleme

“…In addition, suppression of secretion of SHBG in the liver and conversion of testosterone into estradiol in adipose tissues as a result of developing hyperinsulinism due to increase of body weight also adversely affect the sexual functions (2). In a meta-analysis it has been found that, SHBG, LH, FSH, and free and bound testosterone levels increased, and estrogen levels decreased due to weight loss in men after bariatric surgery (6). In another study, increased prolactin and decreased testosterone levels have been associated with decreases in sexual arousal (32).…”

“…Obesity related diseases such as diabetes mellitus, chronic hypertension and respiratory diseases have been developing and distracting the quality of life (5). About 3 million people die annually due to obesity-related complications (6).…”