Body weight loss reverts obesity-associated hypogonadotropic hypogonadism: a systematic review and meta-analysis.
Level 1 - systematic review of randomized trials
Systematic review and meta-analysis of clinical intervention trials
PubMed 23482592 · doi:10.1530/EJE-12-0955
What was done
A systematic review and meta-analysis of studies published between January 1, 1969, and August 31, 2012, identified via Medline. The review evaluated the impact of weight loss achieved via low-calorie diet or bariatric surgery on male sex hormone levels. Out of 266 retrieved articles, 24 studies were included (22 evaluating diet or bariatric surgery separately, and 2 directly comparing diet against bariatric surgery).
What was found
Both low-calorie diet and bariatric surgery were associated with a significant increase in total testosterone (plasma sex hormone-binding globulin-bound and unbound testosterone, P < 0.0001). Bariatric surgery led to a significantly larger increase in total testosterone than low-calorie diet (increase of 8.73 [6.51–10.95] vs 2.87 [1.68–4.07], both P < 0.0001 vs baseline). Weight loss was also associated with reduced estradiol and increased gonadotropin levels. In multiple regression analysis, the magnitude of weight loss was the primary determinant of the testosterone increase (B = 2.50 ± 0.98, P = 0.029), with greater androgen increases observed in younger, non-diabetic men with higher initial degrees of obesity.
Why it matters
This meta-analysis demonstrates that obesity-associated secondary hypogonadism in men is reversible through weight loss, with greater androgen recovery driven directly by greater amounts of weight lost.
Limits
The abstract does not state the total number of individual participants or specify the proportion of randomized versus uncontrolled or prospective observational study designs among the 24 included studies. Measurement units for hormone changes are not reported in the abstract, and long-term maintenance of hormone normalization was not described.
Cited by
- supports Overweight men who lose excess body fat experience an increase in testosterone levels, whereas lean men who undergo severe caloric restriction experience a drop in testosterone.