Highlights
- •Bariatric-metabolic surgery leads to the biochemical resolution of male obesity secondary hypogonadism within the first two years
- •A steeper increase in testosterone levels (baseline to 12 months) corresponds to a higher %EWL
- •No difference between RYGB and OAGB was observed, none of the methods can be favoured in the male patient suffering with obesity suffering from hypogonadism
Abstract
Background
Male obesity secondary hypogonadism (MOSH) is a common disease among men with obesity
and can be associated with metabolic syndrome and a variety of metabolic problems
ultimately leading to androgen deficiency. Metabolic and bariatric surgery is a well-established
treatment option associated with significant weight loss and reduction in metabolic
co-morbidities.
Objectives
To evaluate the impact of surgery on plasma levels of sexual hormones and their effect
on weight loss comparing 2 surgical methods (one-anastomosis gastric bypass [OAGB]
and Roux-en-Y gastric bypass [RYGB]) in male patients with obesity.
Setting
University hospital, Austria.
Methods
Patients undergoing OAGB and RYGB between 2012 and 2017 were analyzed retrospectively.
Follow-up in this study was up to 24 months. Systemic levels of sexual hormones (luteinizing
hormone [LH]), follicle stimulating hormone [FSH], total testosterone [TT], sexual
hormone binding globin [SHBG], 17 beta-estradiol [17bE], androstenedione [AS]) were
retrieved at each visit. A linear mixed model was used to assess the correlation between
changes in testosterone levels and percent excess weight loss (%EWL).
Results
In 30.8% of all patients, MOSH was present preoperatively. A significant increase
of TT was observed postoperatively that led to a complete resolution of hypogonadism
within the period observed. Bioavailable testosterone (bTT) and FSH levels significantly
increased each month of follow-up after surgery (all P < .01). Levels of 17bE did not change significantly after surgery. The overall change
of TT, comparing preoperative and 1-year postoperative TT levels (ΔTT), significantly
correlated with %EWL. Changes in TT levels were not affected by the choice of surgical
method.
Conclusions
Serum plasma testosterone levels rise significantly after metabolic and bariatric
surgery in male patients. The change of testosterone levels seems to play a role in
continued weight loss after surgery. This is true irrespective of the surgical method
used.
Keywords
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Article info
Publication history
Published online: December 29, 2022
Accepted:
December 17,
2022
Received:
August 12,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved.
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- Comment on: The male patient with obesity undergoing bariatric-metabolic surgery: Changes in testosterone levels correlate with weight loss after OAGB and RYGBSurgery for Obesity and Related Diseases
- PreviewMale obesity-associated secondary hypogonadism (MOSH) is among a number of comorbidities and health consequences associated with obesity (1). Although frequently neglected, this disorder has a relevant impact on both patients’ quality of life but also potentially life expectancy. Obesity has been identified as a primary cause of secondary hypogonadism and reproductive dysfunction. Adipose tissue aromatase can reduce testosterone levels by irreversibly converting testosterone to estradiol. Low testosterone levels may lead to alterations in body composition and promote abdominal fat accumulation while obesity, in turn, can further reduce testosterone levels.
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