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Review
. 2014 Mar-Apr;16(2):223-31.
doi: 10.4103/1008-682X.122365.

Lowered testosterone in male obesity: mechanisms, morbidity and management

Mark Ng Tang Fui, Philippe Dupuis, Mathis Grossmann  1
Affiliations
Review

Lowered testosterone in male obesity: mechanisms, morbidity and management

Mark Ng Tang Fui et al. Asian J Androl. 2014 Mar-Apr.

Abstract

With increasing modernization and urbanization of Asia, much of the future focus of the obesity epidemic will be in the Asian region. Low testosterone levels are frequently encountered in obese men who do not otherwise have a recognizable hypothalamic-pituitary-testicular (HPT) axis pathology. Moderate obesity predominantly decreases total testosterone due to insulin resistance-associated reductions in sex hormone binding globulin. More severe obesity is additionally associated with reductions in free testosterone levels due to suppression of the HPT axis. Low testosterone by itself leads to increasing adiposity, creating a self-perpetuating cycle of metabolic complications. Obesity-associated hypotestosteronemia is a functional, non-permanent state, which can be reversible, but this requires substantial weight loss. While testosterone treatment can lead to moderate reductions in fat mass, obesity by itself, in the absence of symptomatic androgen defi ciency, is not an established indication for testosterone therapy. Testosterone therapy may lead to a worsening of untreated sleep apnea and compromise fertility. Whether testosterone therapy augments diet- and exercise-induced weight loss requires evaluation in adequately designed randomized controlled clinical trials.

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Figures

Figure 1
Figure 1
Bidirectional relationship between obesity and low testosterone.
Figure 2
Figure 2
Effect of weight (or body mass index (BMI)) reduction on circulating total testosterone. Each circle represents a single longitudinal study. Size of the circle is proportional to study size. Adapted from Grossmann.
See this image and copyright information in PMC

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