madman
Super Moderator
Purpose of review The prevalence of metabolic syndrome and hypogonadism continues to rise in the United States and around the world. These two conditions are inexorably linked, and understanding their relationship with each other is key to treating men with either of these conditions.
Recent findings Testosterone has been shown to be a key regulator in the maintenance of metabolic homeostasis. A large volume of research has found that testosterone deficiency is closely linked to metabolic syndrome through complex physiologic mechanisms of endothelial dysfunction, inflammation, and glucose metabolism.
Summary Interventions through lifestyle modification and testosterone replacement in hypogonadal men may reduce the morbidity and mortality risks associated with metabolic syndrome.
INTRODUCTION
In the United States, almost 70% of men aged 20 years and older can be classified as overweight [1]. Additionally, the overall prevalence of metabolic syndrome (MetS) in the United States is almost 35%, with greater than 40% of men older than 60 being classified as having MetS [2]. Hypogonadism, also known as testosterone deficiency, similarly impacts a large number of men with approximately 30% of men ages 40–79 years affected [3]. Testosterone has been shown to be a key regulator in the maintenance of metabolic homeostasis. Insight from studies of hypogonadal men undergoing treatment with testosterone replacement therapy (TRT), and additional studies with androgen-deprivation therapy in prostate cancer patients, suggests that testosterone deficiency is closely linked to metabolic syndrome (MetS) through several complex pathways. These pathways include changes in insulin resistance, hyperglycemia, visceral fat accumulation, increases in waist circumference, dyslipidemia, increased synthesis of inflammatory cytokines, and endothelial dysfunction; all ultimately leading to cardiovascular disease [4–10]. Hypogonadism itself has been shown to result in significant changes in body composition with decreased lean body mass, increased fat mass (especially visceral fat mass), and decreased bone mineral density. It is through this lens we review the association between hypogonadism and metabolic syndrome [4].
*DEFINING METABOLIC SYNDROME
*DEFINING HYPOGONADISM
*ASSOCIATIONS BETWEEN HYPOGONADISM AND METABOLIC SYNDROME
*DIABETES AND HYPOGONADISM
*TESTOSTERONE DEFICIENCY AND METABOLIC SYNDROME: INFLUENCE MORBIDITY AND MORTALITY
*LIFESTYLE MODIFICATION IN THE TREATMENT OF METABOLIC SYNDROME AND TESTOSTERONE DEFICIENCY
*TESTOSTERONE THERAPY IMPACT ON METABOLIC SYNDROME
CONCLUSION
The associations of hypogonadism and metabolic syndrome are strong, though bidirectional causality has not been clearly established. The abundance of evidence suggests that hypogonadism and concurrent Mets put men at significant risk for morbidity, specifically diabetes, and also a significant risk of mortality. The impact of both hypogonadism and MetS crosses many medical specialties and is ripe for collaborative treatment and future research endeavors. Most evidence points to testosterone therapy as safe and potentially helpful in reducing morbidity and mortality risks in men with MetS. This is most effective when combined with lifestyle modifications, most importantly regular aerobic exercise. Although testosterone replacement is clearly not a panacea, it can be a helpful adjunct to help enhance a patient’s path to a healthier lifestyle and improved cardiovascular risk.
Recent findings Testosterone has been shown to be a key regulator in the maintenance of metabolic homeostasis. A large volume of research has found that testosterone deficiency is closely linked to metabolic syndrome through complex physiologic mechanisms of endothelial dysfunction, inflammation, and glucose metabolism.
Summary Interventions through lifestyle modification and testosterone replacement in hypogonadal men may reduce the morbidity and mortality risks associated with metabolic syndrome.
INTRODUCTION
In the United States, almost 70% of men aged 20 years and older can be classified as overweight [1]. Additionally, the overall prevalence of metabolic syndrome (MetS) in the United States is almost 35%, with greater than 40% of men older than 60 being classified as having MetS [2]. Hypogonadism, also known as testosterone deficiency, similarly impacts a large number of men with approximately 30% of men ages 40–79 years affected [3]. Testosterone has been shown to be a key regulator in the maintenance of metabolic homeostasis. Insight from studies of hypogonadal men undergoing treatment with testosterone replacement therapy (TRT), and additional studies with androgen-deprivation therapy in prostate cancer patients, suggests that testosterone deficiency is closely linked to metabolic syndrome (MetS) through several complex pathways. These pathways include changes in insulin resistance, hyperglycemia, visceral fat accumulation, increases in waist circumference, dyslipidemia, increased synthesis of inflammatory cytokines, and endothelial dysfunction; all ultimately leading to cardiovascular disease [4–10]. Hypogonadism itself has been shown to result in significant changes in body composition with decreased lean body mass, increased fat mass (especially visceral fat mass), and decreased bone mineral density. It is through this lens we review the association between hypogonadism and metabolic syndrome [4].
*DEFINING METABOLIC SYNDROME
*DEFINING HYPOGONADISM
*ASSOCIATIONS BETWEEN HYPOGONADISM AND METABOLIC SYNDROME
*DIABETES AND HYPOGONADISM
*TESTOSTERONE DEFICIENCY AND METABOLIC SYNDROME: INFLUENCE MORBIDITY AND MORTALITY
*LIFESTYLE MODIFICATION IN THE TREATMENT OF METABOLIC SYNDROME AND TESTOSTERONE DEFICIENCY
*TESTOSTERONE THERAPY IMPACT ON METABOLIC SYNDROME
CONCLUSION
The associations of hypogonadism and metabolic syndrome are strong, though bidirectional causality has not been clearly established. The abundance of evidence suggests that hypogonadism and concurrent Mets put men at significant risk for morbidity, specifically diabetes, and also a significant risk of mortality. The impact of both hypogonadism and MetS crosses many medical specialties and is ripe for collaborative treatment and future research endeavors. Most evidence points to testosterone therapy as safe and potentially helpful in reducing morbidity and mortality risks in men with MetS. This is most effective when combined with lifestyle modifications, most importantly regular aerobic exercise. Although testosterone replacement is clearly not a panacea, it can be a helpful adjunct to help enhance a patient’s path to a healthier lifestyle and improved cardiovascular risk.
Last edited:
