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

Abstract

SUMMARYTo study the prevalence of male obesity-secondary hypogonadism (MOSH) in patients with moderate to severe obesity, we performed a prospective prevalence study including 100 male patients with moderate to severe obesity at a university tertiary hospital. Total testosterone (TT) and sex hormone-binding globulin (SHBG) concentrations among others were assayed in all patients. Serumfree testosterone (FT) concentration was calculated from TT and SHBG levels. Semen analysis was conducted in 31 patients. We found a prevalence of 45% (95% CI: 35-55%) when considering decreased TT and/or FT concentrations. Serum concentrations of TT were correlated negatively with glucose (r = À0.328, p < 0.001) and insulin resistance (r = À0.261, p = 0.011). The same occurred with FT and glucose (r = À0.340, p < 0.001) and insulin resistance (r = À0.246, p = 0.016). Sixty-two percent (95% CI: 39-85%) of the patients with seminogram also presented abnormal results in semen analysis. The frequencies of low TT or low FT values were similar in patients with abnormal or normal semen analysis (p = 0.646 and p = 0.346, respectively). Ejaculate volume inversely correlated with BMI (q = À0.400, p = 0.029) and with excess body weight (q = À0.464, p = 0.010). Our data show the prevalence of MOSH in patients with moderate to severe obesity is high. Low circulating testosterone is associated with insulin resistance and low ejaculate volume with higher BMI and excess body weight. Semen analysis must be performed in these patients when considering fertility whether or not presenting low circulating testosterone.

Obesity and male hypogonadism: Tales of a vicious cycle

“…In another study, in 149 men aged 18 to 66 years with a mean BMI of 42.7 kg/m 2 Hofstra et al not only reported that BMI was inversely correlated with free testosterone but also that 35.6% of men with obesity exhibited free testosterone levels in the hypogonadism range. Calderón et al reported that among 100 men with a mean age of 40.5 years and BMI ≥ 35 kg/m 2 , 45% could be classified as hypogonadal based on low free testosterone levels. In addition, the authors found that low free testosterone levels were associated with increased insulin resistance and low ejaculate volume.…”

Cross‐Sectional, Primary Care–Based Study of the Prevalence of Hypoandrogenemia in Nondiabetic Young Men with Obesity

“…In this clinical study, hypoandrogenemia was associated with the degree of obesity and with impaired erectile function, although the latter was assessed by anamnesis, not with a validated test such as the IIEF‐5 questionnaire. Also, Calderón et al , in a small study involving 100 male patients with moderate to severe obesity, found a prevalence of hypogonadism of 44% when considering decreased TT concentrations and of 34% according to reduced FT concentrations. On the other hand, when men with severe obesity are evaluated, the prevalence of hypoandrogenemia is even higher.…”

The interaction of fasting, caloric restriction, and diet-induced obesity with 17β-estradiol on the expression of KNDy neuropeptides and their receptors in the female mouse

“…For example, hypogonadism secondary to obesity is common, with bariatric surgery correcting a significant percentage of infertility (Calderon et al, 2015, Milone et al, 2015). Similarly, patients with eating disorders have increased spontaneous abortions and miscarriages (Linna et al, 2013).…”