Please use this identifier to cite or link to this item: http://ahro.austin.org.au/austinjspui/handle/1/17525
Title: Hypogonadism and Male Obesity: Focus on Unresolved Questions.
Authors: Grossmann, Mathis
Affiliation: Department of Medicine Austin Health, University of Melbourne, Heidelberg, Australia
Department of Endocrinology, Austin Health, Heidelberg, Victoria, Australia
Issue Date: 23-Apr-2018
EDate: 2018
Citation: Clinical endocrinology 2018; online first: 23 April
Abstract: Obesity, increasing in prevalence globally, is the clinical condition most strongly associated with lowered testosterone concentrations in men, and presents as one of the strongest predictors of receiving testosterone treatment. While low circulating total testosterone concentrations in modest obesity primarily reflect reduced concentrations of sex hormone binding globulin, more marked obesity can lead to genuine hypothalamic-pituitary-testicular axis (HPT) suppression. HPT axis suppression is likely mediated via pro-inflammatory cytokine and dysregulated leptin signalling and aggravated by associated comorbidities. Whether estradiol-mediated negative hypothalamic-pituitary feedback plays a pathogenic role requires further study. Although the obesity-hypogonadism relationship is bi-directional, the effects of obesity on testosterone concentrations are more substantial than the effects of testosterone on adiposity. In markedly obese men submitted to bariatric surgery, substantial weight loss is very effective in reactivating the HPT axis. In contrast, lifestyle measures are less effective in reducing weight and generally only associated with modest increases in circulating testosterone. In randomised controlled clinical trials (RCTs), testosterone treatment does not reduce body weight, but modestly reduces fat mass and increases muscle mass. Short-term studies have shown that testosterone treatment in carefully selected obese men may have modest benefits on symptoms of androgen deficiency and body composition even additive to diet alone. However, longer-term, larger RCTs designed for patient-important outcomes and potential risks are required. Until such trials are available, testosterone treatment cannot be routinely recommended for men with obesity-associated non-classical hypogonadism. Lifestyle measures or where indicated bariatric surgery to achieve weight loss, and optimisation of comorbidities remain first line. This article is protected by copyright. All rights reserved.
URI: http://ahro.austin.org.au/austinjspui/handle/1/17525
DOI: 10.1111/cen.13723
ORCID: 0000-0001-8261-3457
PubMed URL: 29683196
Type: Journal Article
Subjects: androgen
aromatase inhibitor
estradiol
hypogonadism
kisspeptin
leptin
obesity
selective estrogen receptor modulator
testosterone
Appears in Collections:Journal articles

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