Treatment of Functional Hypogonadism Besides Pharmacological Substitution

Corona, Giovanni; Rastrelli, Giulia; Morelli, Annamaria; Sarchielli, Erica; Cipriani, Sarah; Vignozzi, Linda; Maggi, Mario

doi:10.5534/wjmh.190061

Cited by 58 publications

(66 citation statements)

References 70 publications

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“…In men who lost weight during follow‐up, in contrast, T often increased with recovery from secondary hypogonadism . A meta‐analysis of available evidence confirmed that weight loss (obtained by either low‐calorie diet of bariatric surgery) improves T concentrations proportionately to the weight loss obtained . Similar results have also been reported for physical activity .…”

Section: Treatmentsupporting

confidence: 62%

“…A meta‐analysis of available evidence confirmed that weight loss (obtained by either low‐calorie diet of bariatric surgery) improves T concentrations proportionately to the weight loss obtained . Similar results have also been reported for physical activity . The mechanisms underlying such functional alterations in the HPT axis have not been completely clarified.…”

Section: Treatmentmentioning

confidence: 59%

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European Academy of Andrology (EAA) guidelines on investigation, treatment and monitoring of functional hypogonadism in males

et al. 2020

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Background Evidence regarding functional hypogonadism, previously referred to as ‘late‐onset’ hypogonadism, has increased substantially during the last 10 year. Objective To update the European Academy of Andrology (EAA) guidelines on functional hypogonadism. Methods Expert group of academicians appointed by the EAA generated a series of consensus recommendations according to the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) system. Results The diagnosis of functional hypogonadism should be based on both the presence of clinical symptoms supported by repeatedly low morning fasting serum total testosterone (T) measured with a well‐validated assay, after exclusion of organic causes of hypogonadism. Lifestyle changes and weight reduction should be the first approach in all overweight and obese men. Whenever possible, withdrawal/modification of drugs potentially interfering with T production should be advised. Testosterone replacement therapy (TRT) is contraindicated in men with untreated prostate or breast cancer, as well as severe heart failure. Severe low urinary tract symptoms and haematocrit >48%‐50% represent relative contraindications for TRT. Prostate‐specific antigen and digital rectal examination of the prostate should be undertaken in men >40 years of age before initiating TRT to exclude occult prostate cancer. Transdermal T should be preferred for initiation of TRT, whereas gonadotrophin therapy is only recommended when fertility is desired in men with secondary hypogonadism. TRT is able to improve sexual function in hypogonadal men. Other potential positive outcomes of TRT remain uncertain and controversial. Conclusion TRT can reliably improve global sexual function in men with hypogonadism in the short term. Long‐term clinical benefits, and safety of TRT in functional hypogonadism, remain to be fully documented. Clinicians should therefore explicitly discuss the uncertainties and benefits of TRT and engage them in shared management decision‐making.

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Section: Treatmentsupporting

confidence: 62%

Section: Treatmentmentioning

confidence: 59%

European Academy of Andrology (EAA) guidelines on investigation, treatment and monitoring of functional hypogonadism in males

et al. 2020

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“…The results were updated in a following meta-analysis published in 2019 by the same group. In this study, the results of eight studies were pooled, and the significant increase in FT was confirmed [88]. In all, a limited number of studies are reported in the literature on the impact of diet on FT. Based on available data, a positive correlation should be expected between weight loss and change in FT.…”

Section: Effects Of Lifestyle: Diet Onlymentioning

confidence: 63%

The Role of Diet and Weight Loss in Improving Secondary Hypogonadism in Men with Obesity with or without Type 2 Diabetes Mellitus

et al. 2019

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Despite growing recognition of the issue, obesity represents one of the most common public health problems, and its rates are still increasing globally. Among the number of comorbidities and complications associated with obesity, hypogonadism is listed, and this disorder, although frequently neglected, is characterized by a relevant impact on both quality of life and life expectancy. It is generally accepted that hypogonadism secondary to obesity is functional since it is reversible following weight loss. This review summarizes all current research examining the bidirectional relationship between excess body weight and low testosterone levels. Specifically, it evaluates the role that diet, with or without physical activity, plays in improving body weight and hypogonadism in adult and elderly men with obesity, with or without type 2 diabetes mellitus.

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“…Particularly, patients were suspected of functional hypogonadism since they were obese, TT was between 150 and 299 ng/dL, FT was < 65 pg/mL, and there was no suspicious family history (such as isolated hypogonadotropic hypogonadism and/or delayed puberty) or clinical feature (such as new-onset headache, visual impairment, or visual field defect). 5,18,20 The severity of ED was defined according to the International Index…”

Section: Methodsmentioning

confidence: 99%

“…Since obesity and T2DM are included among the functional causes of hypogonadism, then we opted to treat these factors first. 5,20 Providing that TRT cannot be recommended as a means of improving glycemic control, it has to be acknowledged that TRT can enhance the benefits of other interventions, including lifestyles measures, as we have recently reviewed. 52 TRT prevented the diet-associated loss in lean mass without increasing the overall diet-associated weight loss.…”

Section: F I G U R Ementioning

confidence: 99%

Weight loss more than glycemic control may improve testosterone in obese type 2 diabetes mellitus men with hypogonadism

et al. 2020

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Background: Functional hypogonadism is a common disorder among patients with obesity and type 2 diabetes mellitus and could be managed by first treating the underlying causes.Objective: The present study was undertaken to investigate the contribution of body weight and glycemic control to the reversibility of hypogonadism to eugonadism in a real-life setting. Materials and methods:Adult obese male patients with uncontrolled type 2 diabetes mellitus, complaining of mild to moderate erectile dysfunction and suspected of functional hypogonadism evaluated at our institution from 2015 to 2017, were retrospectively included. The gonadal status 3 and 12 months after the glucose-lowering medication prescription was assessed.Results: Seventy-one consecutive patients were enrolled, with 24 (34%) of them achieving total testosterone ≥300 ng/dL (10.4 nM/L) at the end of the study. When they were stratified according to HbA1c and body weight loss, a direct correlation was found for the latter only. Particularly, 94% of patients achieving a body weight loss >10% presented with total testosterone ≥300 ng/dL. An inverse correlation was found for HbA1c, with no higher prevalence of total testosterone ≥300 ng/dL in patients with HbA1c <6.5%. Discussion:The findings are strengthened by the rigorous study design. However, a limited number of patients and glucose-lowering medications could be included. Conclusions:The present study supports the hypothesis that in obese patients with uncontrolled type 2 diabetes mellitus losing weight may have a greater impact on androgens compared to improving glycemic control. Further prospective studies are needed to corroborate this finding. K E Y W O R D Sfunctional hypogonadism, erectile dysfunction, type 2 diabetes mellitus, obesity | 655 GIAGULLI et AL.

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Treatment of Functional Hypogonadism Besides Pharmacological Substitution

Cited by 58 publications

References 70 publications

European Academy of Andrology (EAA) guidelines on investigation, treatment and monitoring of functional hypogonadism in males

European Academy of Andrology (EAA) guidelines on investigation, treatment and monitoring of functional hypogonadism in males

The Role of Diet and Weight Loss in Improving Secondary Hypogonadism in Men with Obesity with or without Type 2 Diabetes Mellitus

Weight loss more than glycemic control may improve testosterone in obese type 2 diabetes mellitus men with hypogonadism

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