Male obesity secondary hypogonadism: effectiveness of ketogenic diet on testicular function

Abstract

Epidemiological studies have reported an association between obesity/metabolic syndrome (MetS) and male reproductive disorders. Endocrine dysfunctions, direct testicular damage, chronic low-grade inflammation, and insulin resistance (IR) are involved in the occurrence of male obesity secondary hypogonadism (MOSH) which in turn alters the metabolic imbalance, creating a sort of vicious circle. Since IR and chronic inflammation state play a pivotal role in MOSH, low-calorie and low-carbohydrate diet protocols may be administered in obese men to improve their metabolic and hormonal profile. The ketogenic diet (KD) has been reported to determine positive effects on body weight, IR, cardio-metabolic risk, hypothalamic-pituitary-testicular (HPT) axis, and prostate with possible improvement of plasma androgens levels, sexual function (SF), and male fertility. This review aims to evaluate the effectiveness of KD on testicular function. Emerging evidence reports that very low-calorie KD (VLCKD) may revert MOSH by restoring HPT axis function and testosterone (T) levels. Moreover, VLCKD could improve SF, prostate health and lower urinary tract symptoms (LUTSs) in overweight/obese male patients. VLCKD may also positively impact spermatogenesis although evidence is still poor. Future studies are warranted to clarify the effectiveness of KD on testicular and prostate gland function