The Significance of Low Testosterone Levels in Obese Men

Low testosterone is frequently found in obese men over all ages. The relationship between obesity and low testosterone levels in men is complex and apparently bidirectional. Low testosterone and SHBG levels predict the development of central obesity and are associated with an increased risk of developing metabolic syndrome and type 2 diabetes and higher mortality rate for cardiovascular disease. By contrast, obesity predicts low total and free testosterone levels. Several mechanisms interfering with the hypothalamic pituitary gonadal axis have been suggested as responsible for low testosterone production in obese subjects without, however, any clear understanding. Life-style measures achieving a substantial weight loss may increase testosterone levels, whereas clear data on whether exogenous testosterone treatment in obese men, without an established hypogonadic state, may improve body fat content, visceral adiposity and insulin resistance are still missing. Further studies on the pathophysiological mechanisms and on the efficacy of testosterone treatment in obese men with low testosterone levels are needed.