Obesity treatment necessitates evidence-based medical interventions. Although lifestyle modifications are highly recommended as an integral part of strategies designed for the treatment and management of obesity, such strategies are not always successful in the long term in most patients due to a high rate of recidivism, which is due in part to a lack of adherence to the prescribed regimen.
The current approved drugs' limited benefits, combined with the unfavorable adverse side-effects of such agents in the long-term management of obesity, have contributed to lower adherence rates and discontinuation of use.
Desirable outcomes in the management of overweight and obesity necessitate the development and use of new well-tolerated and effective agents that can be used in conjunction with lifestyle changes to achieve weight loss.
Lifestyle changes and pharmacotherapeutic agents such as incretin and glucagon-like peptide-1 (GLP-1) receptor agonists, enzyme inhibitors (dipeptidyl peptidase inhibitors), angiopoietin-like proteins, and bariatric surgery are currently used to treat obesity.
Furthermore, a number of FDA-approved drugs for the treatment of obesity have serious adverse side effects and have been withdrawn from the market. As a result, there are few options for managing obesity aside from lifestyle changes, which have only moderate effects on weight loss and are often unsustainable.
We summarize recent findings related to long-term testosterone therapy that improves body composition, specifically weight loss, waist circumference reduction, and BMI. We propose testosterone therapy as a new approach to managing overweight and obesity in men with low testosterone levels.
Testosterone therapy has profound effects on body composition in men with testosterone deficiency (hypogonadism), resulting in reduced fat mass, increased lean body mass (LBM), and significant reductions in anthropometric parameters such as weight, waist circumference, and BMI.
The effects of testosterone therapy on increased LBM and fat mass, as well as changes in anthropometric parameters, were consistently reported in the majority of studies, regardless of testosterone formulation or duration of testosterone treatment.
Testosterone therapy is linked to weight loss, and obesity is linked to low testosterone levels. Low testosterone levels in obesity may be caused by a variety of factors, including increased levels of sex hormone binding globulin (SHBG), low or inappropriate normal levels of luteinizing hormone, adipocyte dysfunction, androgen resistance, and insulin resistance.
When androgen receptor function is lost, the number of adipocytes increases, as does the accumulation of visceral fat. Obesity in men is predicted by low baseline testosterone levels, and normalization of physiological testosterone levels reduces the activity of lipoprotein lipase and tryglycerides.
Testosterone therapy improves insulin sensitivity, lipid oxidation, and fat mass loss while increasing fat free mass. Weight loss is associated with increased testosterone levels. Increased testosterone levels are the result of intervention measures such as diet and exercise or surgical treatment of obesity.
Obesity and testosterone
The primary male hormone is testosterone. As such, it is responsible for our gender's deep voice, large muscles, and strong bones, as well as the development of the male reproductive organs, sperm production and libido, and the typical male pattern of beard growth. When converted to dihydrotestosterone, the hormone stimulates prostate growth, which is a much less welcome sign of manhood for older men.
Testosterone levels rise during puberty and peak in early adulthood, then begin a slow decline in early middle age after a few years of stability. Because the annual drop in testosterone is only 1%, most older men maintain normal levels. However, anything that hastens the decline can push some men into testosterone deficiency.
Obesity causes testosterone levels to drop. A 2007 study of 1,667 men aged 40 and up, for example, discovered that each one-point increase in BMI was associated with a 2% decrease in testosterone.
Furthermore, a 2008 study of 1,862 men aged 30 and up discovered that waist circumference was a better predictor of low testosterone levels than BMI. A four-inch increase in waist size increased a man's chances of having low testosterone by 75%; ten years of aging increased the odds by only 36%. Overall, waist circumference was the most powerful single predictor of developing testosterone deficiency symptoms.
If these two American studies aren't convincing, consider Australian research that discovered nearly one in every seven obese men could benefit from testosterone replacement therapy, a rate that is more than four times higher than in non-obese men.
Obesity and Erectile Dysfunction (ED)
Obese men, however, have an increased risk of ED even with normal testosterone levels. According to a Harvard study, a man with a 42-inch waist is twice as likely as a man with a 32-inch waist to develop the problem.
Brazilian research found a link between abdominal obesity and ED, but only in men over the age of 60.
A California study found that having a BMI of 28 (overweight but not obese) increased a man's chances of developing ED by more than 90%.
Creating a link is one thing; improving erectile function is quite another. A Massachusetts study, on the other hand, discovered that losing weight can help overweight men with ED.
Similar findings were reported by Italian researchers who randomly assigned 110 obese men with ED to either a diet and exercise program or to receive their usual care. More than 30% of the men in the diet and exercise group had corrected their ED without medication after two years, compared to less than 6% in the group that received their usual level of medical care. Men who lost the most weight benefited the most.
Reproductive function
Obesity has a negative impact on sexuality and may impair fertility. Obesity has been linked to low sperm counts and reduced sperm motility in studies conducted in the United States; German researchers reported similar findings in men aged 20 to 30.
Kidney Stones
Men and their partners can suffer greatly psychologically as a result of ED. Kidney stones are less personal, but they cause far more physical pain. Stones affect men twice as often as women, and being overweight increases a man's risk.
A Harvard study of 45,988 men aged 40 to 75 discovered that having a high BMI and having a large waist circumference are both associated with an increased risk of kidney stones.
Men who gain more than 35 pounds after the age of 21 are 39% more likely to develop stones than men who maintain their leanness.
Men who weigh more than 220 pounds are 44 percent more likely than men who weigh less than 150 pounds to have stones.
These American findings do not explain why the link exists, but research from Europe and Asia indicates that overweight people excrete excessive amounts of calcium and other chemicals in their urine, where the chemicals form stones.
Conclusion
Data clearly show a link between obesity, low testosterone levels, and ED. Obesity impairs endothelial function and lowers serum testosterone levels by causing insulin resistance and metabolic syndrome.
Inflammated fat cells' production of cytokines and adipokines, as well as metabolic disturbances, may be causal factors in the development of ED.
Lifestyle changes are regarded as a cornerstone in the fight against obesity. However, this is difficult to maintain in the long run, and the ability to achieve modest weight loss through lifestyle changes is, at best, limited.
Pharmacotherapy combined with lifestyle modification offers an alternative to combating obesity solely through lifestyle changes.
We propose that testosterone therapy in obese men with testosterone deficiency is a safe and effective treatment that results in long-term and significant weight loss.
Testosterone therapy increases LBM, decreases fat mass, and results in sustained and significant weight loss, waist circumference reduction, and BMI reduction. We believe that testosterone therapy in obese men with testosterone deficiency is a novel and effective approach to obesity management.
The fact that this therapy has been used to treat hypogonadism (testosterone deficiency) for the past 7 decades and has been shown to be well tolerated and effective should be added to the armament for the war on obesity.
Read: Our recommended way to increase your t-levels naturally
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