madman
Super Moderator
Important lessons about testosterone therapy- weight loss vs. testosterone therapy for symptom resolution, classical vs. functional hypogonadism, and short term vs. lifelong testosterone therapy
ABSTRACT
In this commentary, we highlight important findings from a notable RCT by Ng Tang Fui et al. 2016 which investigated the effects of testosterone treatment in dieting obese men. First, a myopic focus on weight loss can detract from important improvements in body composition. Second, while weight loss in obese men may increase testosterone levels, this increase is commonly not enough to result in an improvement in symptoms associated with testosterone deficiency. Third, the RCT by Ng Tang Fui et al. adds evidence to the growing number of clinical trials showing that testosterone therapy should not be restricted to men with classical hypogonadism. Finally, the beneficial effects of testosterone therapy are not maintained after cessation of treatment. Currently, the British Society for Sexual Medicine guidelines are the only clinical guidelines which acknowledge that weight loss per se does not automatically translate to resolution of hypogonadal symptoms, that testosterone therapy can greatly benefit men with testosterone deficiency who do not have classical hypogonadism, and that cessation of testosterone therapy causes reappearance of symptoms and reversal of benefits. Lifelong testosterone therapy is therefore recommended for persistent health benefits in most men with testosterone deficiency. Physicians and patients need to be informed of this.
Conclusion
In conclusion, achieving higher testosterone levels during testosterone treatment – albeit still within the safe therapeutic range – may not only prevent loss of lean mass but also possibly contribute to a greater loss of fat mass in the context of a negative energy balance. Further research is warranted to specifically examine the dose-response effects of testosterone treatment on body composition outcomes in conjunction with calorie-restricted diets, as well as during eucaloric conditions.
The RCT by Ng Tang Fui et al. [1] contributes important evidence to the growing number of studies showing that testosterone therapy should not be restricted to men with classical hypogonadism; all men with testosterone deficiency, regardless of cause, safely benefit from testosterone therapy. Ng Tang Fui et al. furthermore provides excellent data showing that weight loss alone – if it is achieved – does not automatically translate to the resolution of hypogonadal symptoms. Ng Tang Fui et al. additionally confirms previous findings that upon termination of testosterone therapy the benefits are not maintained. Lifelong testosterone therapy with regular monitoring to ensure normalization of testosterone levels, i.e. achievement of high enough safe physiological testosterone levels, is therefore likely necessary.
Currently, the BSSM guidelines are the only clinical guidelines which provide guidance on these three aspects of testosterone therapy; weight loss vs. testosterone therapy for symptom resolution, classical vs. functional hypogonadism, and short term vs. lifelong testosterone therapy. We hope this commentary will help health care professionals make more informed decisions and provide better care for their obese patients with hypogonadism.
ABSTRACT
In this commentary, we highlight important findings from a notable RCT by Ng Tang Fui et al. 2016 which investigated the effects of testosterone treatment in dieting obese men. First, a myopic focus on weight loss can detract from important improvements in body composition. Second, while weight loss in obese men may increase testosterone levels, this increase is commonly not enough to result in an improvement in symptoms associated with testosterone deficiency. Third, the RCT by Ng Tang Fui et al. adds evidence to the growing number of clinical trials showing that testosterone therapy should not be restricted to men with classical hypogonadism. Finally, the beneficial effects of testosterone therapy are not maintained after cessation of treatment. Currently, the British Society for Sexual Medicine guidelines are the only clinical guidelines which acknowledge that weight loss per se does not automatically translate to resolution of hypogonadal symptoms, that testosterone therapy can greatly benefit men with testosterone deficiency who do not have classical hypogonadism, and that cessation of testosterone therapy causes reappearance of symptoms and reversal of benefits. Lifelong testosterone therapy is therefore recommended for persistent health benefits in most men with testosterone deficiency. Physicians and patients need to be informed of this.
Conclusion
In conclusion, achieving higher testosterone levels during testosterone treatment – albeit still within the safe therapeutic range – may not only prevent loss of lean mass but also possibly contribute to a greater loss of fat mass in the context of a negative energy balance. Further research is warranted to specifically examine the dose-response effects of testosterone treatment on body composition outcomes in conjunction with calorie-restricted diets, as well as during eucaloric conditions.
The RCT by Ng Tang Fui et al. [1] contributes important evidence to the growing number of studies showing that testosterone therapy should not be restricted to men with classical hypogonadism; all men with testosterone deficiency, regardless of cause, safely benefit from testosterone therapy. Ng Tang Fui et al. furthermore provides excellent data showing that weight loss alone – if it is achieved – does not automatically translate to the resolution of hypogonadal symptoms. Ng Tang Fui et al. additionally confirms previous findings that upon termination of testosterone therapy the benefits are not maintained. Lifelong testosterone therapy with regular monitoring to ensure normalization of testosterone levels, i.e. achievement of high enough safe physiological testosterone levels, is therefore likely necessary.
Currently, the BSSM guidelines are the only clinical guidelines which provide guidance on these three aspects of testosterone therapy; weight loss vs. testosterone therapy for symptom resolution, classical vs. functional hypogonadism, and short term vs. lifelong testosterone therapy. We hope this commentary will help health care professionals make more informed decisions and provide better care for their obese patients with hypogonadism.
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