Hypogonadism as an additional indication for bariatric surgery in male morbid obesity?

Abstract

Objective: Male obesity is often associated with reduced levels of circulating total (TT) and calculated free testosterone (cFT), with normal/reduced gonadotropins. Bariatric surgery often improves sex steroid and sex hormone-binding globulin (SHBG) levels. The aim of this study was to assess the effects of bariatric surgery on waist circumference (WC) and BMI, and on TT levels, in morbidly obese men, stratified, according to the gonadal state, in eugonadal and hypogonadal (TT!8 nmol/l) subjects. Design: A cohort of morbidly obese patients (29 with hypogonadism (HG) and 26 without) undergoing bariatric surgery (37, 10, 6, and 2, with Roux-en-Y gastric bypass, laparoscopic adjustable gastric banding, biliopancreatic diversion and gastric sleeve, respectively) was studied at 6 and 12 months from the operation. Methods: Anthropometric parameters (weight, BMI, WC) and sex hormones (gonadotropins, TT, cFT, estradiol (E 2 ), SHBG) were assessed. Results: WC was the only parameter significantly correlated with androgens, but not with E 2 , SHBG, and gonadotropins, at baseline. After surgery, a significant increase in TT, cFT, and SHBG, accompanied by a decrease in E 2 , was evident in the two groups. However, both TT and cFT, but not E 2 , SHBG, and gonadotropin variations, were significantly higher in the hypogonadal group at follow-up, with an overall 93% complete recovery from HG. Reduction in WC, but not BMI, was significantly greater in hypogonadal men (DWCZK29.4G21.6 vs K14.4G17.4 at 12 months, PZ0.047). Conclusions: Recovery from obesity-associated HG is one of the beneficial effects of bariatric surgery in morbidly obese men. The present findings suggest that the gonadal state is a predictor of WC decrease after bariatric surgery.

Prevalence of male secondary hypogonadism in moderate to severe obesity and its relationship with insulin resistance and excess body weight

“…PCOS and MOSH have been found in approximately 50% and 60% of severely obese female and male patients submitted to bariatric surgical procedures (Escobar‐Morreale et al ., ; Calderon et al ., ). Of note, the marked weight loss that occurs after bariatric surgery results into remission of the hormonal derangements present in PCOS (Escobar‐Morreale et al ., ) and MOSH (Botella‐Carretero et al ., ; Calderon et al ., ; Samavat et al ., ) in almost all patients. The latter has been confirmed by a recent meta‐analysis showing that bariatric surgery induces an increase in both total testosterone (TT) and free testosterone (FT), the normalization of serum sex hormone‐binding globulin (SHBG), and the remission of MOSH in a large proportion of patients (Corona et al ., ).…”

“…The latter has been confirmed by a recent meta‐analysis showing that bariatric surgery induces an increase in both total testosterone (TT) and free testosterone (FT), the normalization of serum sex hormone‐binding globulin (SHBG), and the remission of MOSH in a large proportion of patients (Corona et al ., ). Therefore, it is not surprising why MOSH have been recently proposed as an indication for bariatric surgery (Lucchese & Maggi, ; Samavat et al ., ).…”

Obesity and male hypogonadism: Tales of a vicious cycle

“…In addition, observational data derived from several studies showed that bariatric surgery is also very effective in increasing testosterone levels and recovering the HPT axis function . Interestingly, hypogonadal men were reported to lose more weight than eugonadal men when submitted to bariatric surgery . Thus, it is hypothesized that the weight loss reverts the vicious cycle, as allows the recovery of testosterone to physiological levels, while in turn increased testosterone decreases weight gain due to its inhibitory effects on adipocytes differentiation and lipid uptake and ultimately allowing to recover the metabolic balance.…”

Obesity and late-onset hypogonadism

“…In the last few years, four additional reports have evaluated the effect of surgery-induced weight loss on T production (Mora et al, 2013, Aarts et al, 2014, Calderón et al, 2014, Mihalca et al 2014). In addition, an update of a previous series was published (Samavat et al, 2014). Hence, so far, 15 observational studies (Bastounis et al 1998, Mingrone et al, 2002, Globerman et al 2005, Alagna et al 2006, Hammoud et al 2009, Omana et al 2009, Reis et al, 2010, Pellitero et al 2012 Mora et al, 2013;Aarts et al, 2014;Calderón et al, 2014, Mihalca et al 2014and Samavat et al, 2014 are available enrolling overall 398 patients, with a mean follow-up of 54.7 weeks, mean BMI of 48.6 kg/m 2 and mean age of 42.1 years (Table 1).…”