Leptin is an adipocyte-secreted hormone important in energy homeostasis and diverse physiological processes. A circulating soluble form of the leptin receptor [soluble leptin receptor (sOB-R)] is the main leptinbinding protein and determinant of free leptin index (FLI), the presumed biologically active form of leptin. We performed observational and interventional studies to elucidate the regulation of sOB-R and FLI in humans. In a cross-sectional study (n ؍ 118), leptin, gender, and adiposity were significant determinants of sOB-R. By multivariate analysis, estradiol (E2) and testosterone predict sOB-R, whereas insulin predicts leptin and FLI. In a frequent-sampling study (n ؍ 6), sOB-R followed a significant circadian rhythm inverse to that of leptin, suggesting that leptin's biological activity may have an even more pronounced diurnal variation than originally thought. A 72-h fast in eight men decreased leptin levels by 80% and increased lymphocyte expression of leptin receptor mRNA and serum sOB-R levels by 100%. Physiological and pharmacological doses of recombinantmethionyl human leptin (rhLeptin) administered to fasted men prevented the fasting-induced increase of sOB-R levels, and pharmacological doses resulted in a decrease in sOB-R levels. These studies provide evidence that sOB-R is regulated by gender, adiposity, hormones, and rhLeptin administration. This may have important implications for the biological activity of leptin in disease states associated with abnormal leptin levels (e.g., obesity and anorexia nervosa). Diabetes 51: 2105-2112, 2002 L eptin, the protein product of the ob gene, is produced by adipose tissue and is secreted into circulation. It acts mainly in the hypothalamus but also in other tissues by binding to specific leptin receptors, which belong to the cytokine receptor family (1,2). Multiple isoforms of the leptin receptor are generated through alternative splicing of the leptin receptor gene, including a long isoform expressed primarily in the hypothalamus and several short isoforms with a much wider tissue distribution (3). A soluble form of the leptin receptor [soluble leptin receptor (sOB-R)], consisting of only the extracellular region (4), binds leptin with an affinity similar to that of membrane-bound receptors (5) and represents the main leptin binding activity in serum (6).Recent work in rodent models has demonstrated that the sOB-R modulates serum leptin levels by delaying its clearance and determines the amount of free versus bound leptin in serum (7). It has also been proposed that free leptin, the form present in cerebrospinal fluid (CSF), is the biologically active form of leptin (8). These data suggest that sOB-R plays an important role in the pathophysiology of energy homeostasis in rodents (7) and humans (9). Thus, understanding the regulation of circulating sOB-R and free leptin in humans may have important physiological and therapeutic implications for human obesity and eating disorders.In obese subjects, a significantly higher percentage of leptin circulat...