Effects of Bariatric Surgery on Male Obesity-Associated Secondary Hypogonadism: Comparison of Laparoscopic Gastric Bypass with Restrictive Procedures

Abstract

Bariatric surgery results in the complete resolution of male obesity-associated secondary hypogonadism (MOSH) in many patients. However, the effects of different bariatric surgical procedures on male sexual hormone profiles and sexual dysfunction have not been compared to date. We compared the pre- and post-operative (at least 6 months after initial surgery) sex hormone profiles of 20 severely obese men submitted to laparoscopic gastric bypass (LGB) with 15 similar patients submitted to restrictive techniques (sleeve gastrectomy in 10 and adjustable gastric banding in 5). We calculated free testosterone (FT) levels from total testosterone (TT) and sex hormone binding globulin (SHBG) concentrations. Fasting glucose and insulin levels served for homeostatic model assessment of insulin resistance (HOMAIR). MOSH was present in 25 and 16 of the 35 patients when considering TT and FT concentrations respectively, resolving after surgery in all but one of them. When considering all obese men as a whole, patients submitted to LGB or restrictive procedures did not differ in terms of excess weight loss, in the decrease of fasting glucose and insulin, HOMAIR and waist circumference, or in the increase of serum 25-hydroxyvitamin D, TT and FT levels. The improvement in TT correlated with the decrease in fasting glucose (r = -0.390, P = 0.021), insulin (r = -0.425, P = 0.015) and HOMAIR (r = -0.380, P = 0.029), and with the increase in SHBG (r = 0.692, P < 0.001). The increase in FT correlated with the decrease in fasting glucose (r = -0.360, P = 0.034). LGB and restrictive techniques are equally effective in producing a remission of MOSH.

Obesity and male hypogonadism: Tales of a vicious cycle

“…In contrast to conservative interventions, bariatric surgery is reported as a very effective means of achieving significant and sustained weight loss in severely patients with obesity. In addition, observational data derived from several studies showed that bariatric surgery is also very effective in increasing testosterone levels and recovering the HPT axis function . Interestingly, hypogonadal men were reported to lose more weight than eugonadal men when submitted to bariatric surgery .…”

“…In addition, observational data derived from several studies showed that bariatric surgery is also very effective in increasing testosterone levels and recovering the HPT axis function. 89,133 Interestingly, hypogonadal men were reported to lose more weight than eugonadal men when submitted to bariatric surgery. 134 Thus, it is hypothesized that the weight loss reverts the vicious cycle, as allows the recovery of testosterone to physiological levels, while in turn increased testosterone decreases weight gain due to its inhibitory effects on adipocytes differentiation and lipid uptake and ultimately allowing to recover the metabolic balance.…”

Prevalence of male secondary hypogonadism in moderate to severe obesity and its relationship with insulin resistance and excess body weight

“…PCOS and MOSH have been found in approximately 50% and 60% of severely obese female and male patients submitted to bariatric surgical procedures (Escobar‐Morreale et al ., ; Calderon et al ., ). Of note, the marked weight loss that occurs after bariatric surgery results into remission of the hormonal derangements present in PCOS (Escobar‐Morreale et al ., ) and MOSH (Botella‐Carretero et al ., ; Calderon et al ., ; Samavat et al ., ) in almost all patients.…”

“…PCOS and MOSH have been found in approximately 50% and 60% of severely obese female and male patients submitted to bariatric surgical procedures (Escobar‐Morreale et al ., ; Calderon et al ., ). Of note, the marked weight loss that occurs after bariatric surgery results into remission of the hormonal derangements present in PCOS (Escobar‐Morreale et al ., ) and MOSH (Botella‐Carretero et al ., ; Calderon et al ., ; Samavat et al ., ) in almost all patients. The latter has been confirmed by a recent meta‐analysis showing that bariatric surgery induces an increase in both total testosterone (TT) and free testosterone (FT), the normalization of serum sex hormone‐binding globulin (SHBG), and the remission of MOSH in a large proportion of patients (Corona et al ., ).…”

A nontargeted study of muscle proteome in severely obese women with androgen excess compared with severely obese men and nonhyperandrogenic women

“…Moreover, obesity-associated gonadal dysfunction consists of hyperandrogenism in women (2) but hypogonadism in men (3). proliferation is influenced by the balance of sex hormones in healthy men and women (4).…”