Testosterone in Men with Obesity and Hypogonadism

Men with obesity often have low testosterone levels, due to low concentrations of sex hormone binding globulin (SHBG). The authors note that it is essential to measure morning serum free testosterone when evaluating low total testosterone in a man with obesity.

Men with testosterone deficiency frequently experience energy imbalance, impaired glucose control, reduced insulin sensitivity, dyslipidemia, increased abdominal fat mass, and reduction in lean body mass. The authors note that testosterone replacement in men with obesity and hypogonadism “has demonstrated favorable results,” and is associated with weight loss, improvements in fasting plasma glucose, insulin resistance (HOMA-IR), triglyceride levels, treadmill duration, high-density lipoprotein cholesterol, lean body mass and waist circumference, and other metabolic and body composition parameters.


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Signs and symptoms that might indicate hypogonadism include decreased energy, libido, muscle mass and body hair, hot flashes, gynecomastia, and infertility.

The most common method of testosterone replacement is topical and preferable to intramuscular injections. But testosterone injection may be beneficial for patients with diminished personal disease management skills or resources because it does not require daily administration. Implantable testosterone pellets are available and offer a longer-term alternative, but can be inadvertently transferred to other people via prolonged skin contact.

A list of available testosterone therapies can be found here

Conclusions

The authors emphasize that it is essential for clinicians to “carefully review” a patient’s medications to identify any that might be contributing to weight gain or impeding weight loss. If pharmacotherapy for weight loss is indicated, its success will “require tailoring treatment to each patient’s unique behaviors and comorbidities.”

Maintaining weight loss “requires a long-term approach with chronic treatment and follow-up to prevent relapse,” they say. They note that weight loss medications are underused, perhaps due to the “paucity of physicians trained in the field, lack of reimbursement for office visits, and poor insurance coverage of weight loss medications.” They suggest that these are “all areas that need improvement in order to better treat obesity as a chronic disease.”

References

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    2. Jensen MD, Ryan DH, Apovian CM, et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and he Obesity Society. J Am Coll Cardiol. 2014;63(25 Pt B):2985–3023.

    3. Apovian CM, Aronne LJ, Bessesen DH, et al. Pharmacological management of obesity: an endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2015;100(2):342–62

    4. Garvey WT, Mechanick JI, Brett EM, et al. American Association of Clinical Endocrinologist and American College of Endocrinology Comprehensive Clinical Practice Guidelines for Medical Care of Patients with Obesity. Endocr Pract. 2016 Jul;22 Suppl 3:1-203