madman
Super Moderator
Abstract
Obesity is currently one of the most serious public health problems which affect up to 30-40% of the population, and its prevalence is higher in men than in women. Complications of obesity include atherosclerosis, cardiovascular diseases, and type 2 diabetes mellitus, but it also has a negative impact on the hormonal system and fertility. The hormonal consequence of excess body fat in men is functional hypogonadism, which not only causes clinical symptoms of testosterone deficiency but is also a risk factor for obesity (a vicious circle mechanism). Reduced fertility in obese men may be a consequence of functional hypogonadotropic hypogonadism (decreased gonadotropins and testosterone secretion, reduced libido, and erectile dysfunction), but other mechanisms associated with excess adipose tissue, like hyperinsulinaemia, hyperleptinaemia, chronic inflammation, and oxidative stress also play an important role. Therefore, in obese men deterioration of semen parameters (sperm concentration, motility, and morphology) and reduced fertility are observed, also concerning the effectiveness of assisted reproductive techniques. Reducing the mass of adipose tissue causes an increase in testosterone concentrations and has a beneficial effect on semen parameters. Functional hypogonadism in obese men should be diagnosed only after the exclusion of organic causes of hypogonadism. Lifestyle changes, including physical exercise, a low-calorie diet, and optimization of comorbidities, are still the first line of treatment. In some patients, if such treatment is ineffective, pharmacotherapy or bariatric surgery may be considered. Testosterone replacement therapy is contraindicated in obese men with functional hypogonadism, especially in those who desire fertility. Selective oestrogen receptor modulators and aromatase inhibitors improve sperm quality but are not recommended for the treatment of hypogonadism in obese men. GLP-1 analogues appear to be effective and safe in the treatment of low testosterone and infertility in obese men and maybe the main method of pharmacotherapy in the future.
*Pathogenesis of functional hypogonadism obese men
-Aromatisation of testosterone to estradiol in fat tissue
-SHBG and obesity
-Insulin resistance and obesity
-Leptin resistance, kisspeptin, and obesity
-Proinflammatory cytokines and obesity
-Summary model of GnRH secretion regulation in obese men
*Testosterone levels in obese men
*Erectile dysfunction, FH, and obesity
*Fertility and obesity in men
*Management of obesity in men
-lifestyle changes
-Bariatric surgery
-Aromatase inhibitors (AI) and selective oestrogen-receptor modulators (SORM)
-Testosterone replacement therapy (TRT)
-GLP-1 analogue treatment
Conclusions
1. FH and fertility disorders are common consequences of obesity in men.
2. ED is a common symptom in obese and especially hypogonadal men.
3. FH should be diagnosed only after the exclusion of organic causes of hypogonadism and based on the presence of clinical symptoms or signs of T deficiency in combination with consistently low morning serum T concentrations. In addition to morning total T, LH should also be measured in all patients with suspected FH, to differentiate between the primary and secondary causes.
4. Lifestyle changes, including physical exercise and weight reduction, in obese men with FH are recommended.
5. TRT is contraindicated in obese men with FH, especially in those who desire fertility.
6. SERMs and AI are effective in improving quality, but their usefulness in the treatment of FH is controversial and not supported by randomised trials.
7. GLP-1 analogues appear to be effective and safe in the treatment of FH and infertility in obese men, but more randomized trials are needed
Obesity is currently one of the most serious public health problems which affect up to 30-40% of the population, and its prevalence is higher in men than in women. Complications of obesity include atherosclerosis, cardiovascular diseases, and type 2 diabetes mellitus, but it also has a negative impact on the hormonal system and fertility. The hormonal consequence of excess body fat in men is functional hypogonadism, which not only causes clinical symptoms of testosterone deficiency but is also a risk factor for obesity (a vicious circle mechanism). Reduced fertility in obese men may be a consequence of functional hypogonadotropic hypogonadism (decreased gonadotropins and testosterone secretion, reduced libido, and erectile dysfunction), but other mechanisms associated with excess adipose tissue, like hyperinsulinaemia, hyperleptinaemia, chronic inflammation, and oxidative stress also play an important role. Therefore, in obese men deterioration of semen parameters (sperm concentration, motility, and morphology) and reduced fertility are observed, also concerning the effectiveness of assisted reproductive techniques. Reducing the mass of adipose tissue causes an increase in testosterone concentrations and has a beneficial effect on semen parameters. Functional hypogonadism in obese men should be diagnosed only after the exclusion of organic causes of hypogonadism. Lifestyle changes, including physical exercise, a low-calorie diet, and optimization of comorbidities, are still the first line of treatment. In some patients, if such treatment is ineffective, pharmacotherapy or bariatric surgery may be considered. Testosterone replacement therapy is contraindicated in obese men with functional hypogonadism, especially in those who desire fertility. Selective oestrogen receptor modulators and aromatase inhibitors improve sperm quality but are not recommended for the treatment of hypogonadism in obese men. GLP-1 analogues appear to be effective and safe in the treatment of low testosterone and infertility in obese men and maybe the main method of pharmacotherapy in the future.
*Pathogenesis of functional hypogonadism obese men
-Aromatisation of testosterone to estradiol in fat tissue
-SHBG and obesity
-Insulin resistance and obesity
-Leptin resistance, kisspeptin, and obesity
-Proinflammatory cytokines and obesity
-Summary model of GnRH secretion regulation in obese men
*Testosterone levels in obese men
*Erectile dysfunction, FH, and obesity
*Fertility and obesity in men
*Management of obesity in men
-lifestyle changes
-Bariatric surgery
-Aromatase inhibitors (AI) and selective oestrogen-receptor modulators (SORM)
-Testosterone replacement therapy (TRT)
-GLP-1 analogue treatment
Conclusions
1. FH and fertility disorders are common consequences of obesity in men.
2. ED is a common symptom in obese and especially hypogonadal men.
3. FH should be diagnosed only after the exclusion of organic causes of hypogonadism and based on the presence of clinical symptoms or signs of T deficiency in combination with consistently low morning serum T concentrations. In addition to morning total T, LH should also be measured in all patients with suspected FH, to differentiate between the primary and secondary causes.
4. Lifestyle changes, including physical exercise and weight reduction, in obese men with FH are recommended.
5. TRT is contraindicated in obese men with FH, especially in those who desire fertility.
6. SERMs and AI are effective in improving quality, but their usefulness in the treatment of FH is controversial and not supported by randomised trials.
7. GLP-1 analogues appear to be effective and safe in the treatment of FH and infertility in obese men, but more randomized trials are needed
