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Nelson Vergel

"One may argue that testosterone therapy has been around for more than 75 years and no data have been reported on the effects of testosterone on weight loss, until recently. So, why now and how could this be explained? Several key reasons explain this deficit in the literature. First, most studies reported on testosterone therapy were of very short duration and this does not permit necessary tissue remodeling and changes in LBM and fat mass, which require longer time periods. Second, testosterone formulations used in many prior studies did not provide sustained physiological levels of testosterone and in most cases the circulating testosterone levels were suboptimal, thus resulting in incomplete responses. Third, in addition, poor patients’ compliance to testosterone therapy is of paramount importance in the effectiveness of testosterone therapy. These factors explain, in part, the neutral effects of testosterone therapy on weight observed in some studies. Schoenfeld et al.[118] showed that adherence rates to testosterone therapy are variable depending on formulations and therefore different outcomes are expected.

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It should be noted that testosterone deficiency is associated with a shift in fuel metabolism from lipid oxidation toward glucose utilization [119] and testosterone therapy [51,120] increased muscle mass and lipid oxidation in aging men. Furthermore, higher endogenous circulating testosterone levels were associated with reduced loss of LBM in elderly men [121] and testosterone therapy in frail men preserves muscle thickness [122]. Thus, it is not surprising that in obese men with testosterone deficiency, long-term testosterone therapy with formulations that achieve physiological levels, along with adequate adherence, produced significant and sustained weight loss, concomitant with reduction in waist circumference and BMI (Table (Table2,2, Figs Figs11 and and2)2) [23▪▪,2744,45▪,46▪▪,4756,57▪,58▪▪61▪▪,62▪,63▪,6466,72]. Further, long-term testosterone therapy in men with testosterone deficiency produced improvements in cardio-metabolic function, ameliorated metabolic syndrome components, reduced fatigue, increased vigor and energy and improved quality of life [62▪,63▪,6466,103▪▪,104107,123]. We suggest that testosterone therapy offers well tolerated and effective treatment of obesity in men with testosterone deficiency and this novel approach provides a unique opportunity to manage obese men."

Full paper: Testosterone and weight loss: the evidence
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