Short-term impact of tirzepatide on metabolic hypogonadism and body composition in patients with obesity: a controlled pilot study.
Level 3 - non-randomized controlled study
Non-randomized controlled prospective cohort/pilot study
PubMed 40604795 · doi:10.1186/s12958-025-01425-9
What was done
A controlled pilot study evaluated 83 men with obesity (mean age 55.3 ± 5.5 years) and metabolic hypogonadism. All participants followed a hypocaloric diet and walked briskly for 20 minutes daily. Patients were allocated to three groups for 2 months: Group A received weekly subcutaneous tirzepatide (2.5 mg weekly for 1 month, then 5 mg weekly; n = 28); Group B received no pharmacological treatment (lifestyle only; n = 30); and Group C received transdermal testosterone (n = 25). Evaluations at 2 months assessed body composition, the Binge Eating Scale (BES), erectile function via the IIEF-5 questionnaire, and serum hormone levels including LH, FSH, SHBG, total testosterone, 17β-estradiol, and calculated free and bioavailable testosterone.
What was found
Significant baseline differences existed between groups: waist circumference was higher in Group B, while BES score, lean mass, and serum LH were higher in Group A. At 2 months, Group A had significantly greater reductions in body weight, waist circumference, BES score, and fat mass, with significantly greater increases in lean mass and IIEF-5 scores compared to Groups B and C. Group A also showed significantly higher serum levels of LH, FSH, SHBG, total testosterone, free testosterone, and bioavailable testosterone, and significantly lower 17β-estradiol compared to Groups B and C. Absolute numerical values, effect sizes, and exact p-values were not reported in the abstract.
Why it matters
This study suggests dual GIP/GLP-1 receptor agonism may help restore endogenous hypothalamic-pituitary-gonadal axis activity and improve erectile dysfunction in obesity-related functional hypogonadism, potentially outperforming exogenous testosterone therapy.
Limits
The study was non-randomized, resulting in notable baseline differences between cohorts in anthropometrics, eating behavior, and baseline LH levels. The sample size was small (83 patients across three arms), the duration was short (2 months), and the abstract provides no numerical data, confidence intervals, or safety outcomes.
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