Weight loss and sex steroid metabolism in massively obese man

Abstract

To evaluate the effect of weight loss and diet therapy on plasma sex hormone behavior in male obesity, 9 men with a BMI of 43.4 +/- 6.3 participated in an 8-week semistarvation program [whose energy content ranged from 320 to 500 k calorie/day (proteins 44 to 60 g and carbohydrates 54 to 81 g per day)] followed by a two-week hypocaloric (1000 k calorie/day) refeeding. In basal conditions, obese patients presented higher estrogen and lower dehydroepiandrosterone sulphate, testosterone (total and free) and sex-hormone binding globulin concentrations with respect to a group of control normal-weight subjects. Cumulative weight loss was 23.9 +/- 3.6 kg after semistarvation and 24.4 +/- 4.8 kg after refeeding (p = NS). A significant increase in testosterone, free testosterone and dehydroepiandrosterone sulfate was observed throughout the study, irrespective of dietary intake. A transient increase occurred in estrone levels while 17B-estradiol did not change. Gonadotropins and sex-hormone binding globulin values remained unaltered. No relationship was found between sex hormones and dietary energy content or composition. Daily urine free cortisol, which was used as a parameter of adrenal function, fell approximately 50% during semistarvation but returned to baseline values after refeeding. These results show that in massively obese patients weight loss per se may partially reverse sex hormone abnormalities but not sex-hormone binding globulin concentrations. It remains to be determined whether the return to "normal weight" can normalize steroid metabolic derangements in the obese man.

Sex-Specific Effects of High Fat Diet on Indices of Metabolic Syndrome in 3xTg-AD Mice: Implications for Alzheimer's Disease

“…We found that high fat diet resulted in significant depletion of testosterone in males, but not significant loss of estrogens in females. Obesity-induced hypogonadism has been previously described in rats [35] and humans [36], [37], and evidence suggests that the loss of testosterone in males may in turn accelerate obesity and metabolic dysfunction [38]–[41]. In fact, clinical studies have found that testosterone therapy can reduce features of metabolic syndrome [42]–[45].…”

Body weight loss reverts obesity-associated hypogonadotropic hypogonadism: a systematic review and meta-analysis

“…Few randomized clinical studies have specifically evaluated the impact of diet and physical activity on testosterone levels in obese men. The results of these studies are essentially conflicting: some of them showed an increase of testosterone (26,27,28,29,30,31,32,33,34), others showed no change (35,36,37,38,39), and one small study has shown even a decrease in testosterone levels (40). Similarly, in the last 10 years, several trials have evaluated the impact of bariatric surgery on testosterone levels in men generally, showing an increase in testosterone levels (41,42,43,44,45,46,47,48).…”

High Prevalence of Prolonged QT Interval in Obese Hypogonadal Males

“…(6,8) Indeed, the risk of hypogonadism in obese men is approximately twofold higher than in normal weight individuals (9). The link between excess weight and low testosterone levels is also strengthened by the reversal of sex hormone abnormalities after weight loss (10). No study has yet evaluated whether hypoandrogenism contributes to QT interval prolongation among male obese patients, indeed, no specific cause for prolonged QT interval in obese subjects has yet been identified (3,11,12).…”