Obesity’s role in secondary male hypogonadism: a review of pathophysiology and management issues

Abstract

Obesity and male hypogonadism are both associated with one another. Moreover, male hypogonadism can serve as a risk factor for obesity while obesity can serve as a risk factor for male hypogonadism. There has been little research regarding obesity and its reduction on that of gonadal function. Lifestyle factors as well as other factors have been attributed to the development of obesity which can induce gonadal dysfunction. Therefore, the treatment of male hypogonadism is of great interest for both providers and patients. The future of hypogonadism therapy may exist with the development of aromatase inhibitors that can minimize undesired effects and allow the benefits of androgens. Testosterone treatment can lead to compromised fertility and addiction. Aromatase allows for the peripheral conversion of androgens into estrogens resulting in the inhibition of gonadotropin production. Therefore, aromatase inhibitors can be used instead to increase gonadotropin secretion. There is growing evidence that aromatase inhibitors can improve the fertility and raise testosterone levels.

Worse progression of COVID‐19 in men: Is testosterone a key factor?

“…To support this hypothesis, it should be considered that visceral obesity per se fosters higher level of pro‐thrombotic circulating factors, thus, predisposing to thrombosis 159 . Moreover, obesity and male hypogonadism are both associated with one other 160 . The so‐called “male obesity‐related secondary hypogonadism” is frequently found in obese men and is characterized by a complex and multifactorial pathogenesis, 161 which includes adipose tissue dysfunction, T‐to‐estrogen shunt, impaired release of hypothalamic gonadotropin‐releasing hormone, insulin resistance and obstructive sleep apnea 162 .…”

“…159 Moreover, obesity and male hypogonadism are both associated with one other. 160 The so-called "male obesity-related secondary hypogonadism" is frequently found in obese men and is characterized by a complex and multifactorial pathogenesis, 161 Body mass index positively correlates with circulating levels of estrogen and negatively correlate with circulating T also in humans. 167 Aromatase gene expression is enhanced in men adipose tissue, and is positively related with body weight and levels of systemic inflammation, therefore confirming same results observed in animal models.…”

Hypothesized mechanisms explaining poor prognosis in type 2 diabetes patients with COVID-19: a review

“…Furthermore, visceral obesity is more prevalent in men than women and this biological phenomenon has been hypothesized to have a putative role in driven poor prognosis of COVID-19 especially in men. From this point of view, male obesity is usually associated with a functional hypogonadism and these clinical conditions are both associated with one other [ 123 ], according to a complex and multifactorial pathogenesis [ 124 ] that fosters higher baseline levels of inflammation and endothelial dysfunction [ 125 ]. Aromatase gene expression is enhanced by prostaglandin E 2 , whose levels were found to be higher in visceral adipose tissue of obese men [ 126 ].…”

Male Obesity Associated Gonadal Dysfunction and the Role of Bariatric Surgery

“…Hypogonadism is defined as decreased or absent gonadal function and in males is characterized by reduced testosterone levels (4). There exists an expectation that testosterone levels will naturally decline with age and can lead to or strongly contribute to hypogonadism (5). Obesity and in particular, visceral adipose tissue expansion, represents a strong risk factor for the development of male hypogonadism and this state is referred to as male obesity secondary hypogonadism (MOSH) (6).…”