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What is the association between obesity and hypogonadism? How will vpscogni_TUusererone therapy benefit obese hypogonadal patients?
Response by Richard Sadovsky, MD, Posted 12/15/07

It is well known that obesity is associated with increased cardiovascular risks, hypertension, dyslipidemia, endothelial dysfunction, type 2 diabetes, and impaired glucose tolerance.1 In addition to these complications, visceral obesity in male patients is also associated with decreased total and free vpscogni_TUusererone levels, which may lead to the development of hypogonadism.2

Visceral obesity, insulin resistance, and cardiovascular disease (CVD) are all associated with hypogonadism and are components of metabolic syndrome.3 Recent evidence suggests that the confounding factor between metabolic syndrome and hypogonadism may be increased body mass index (BMI), which is inversely correlated with both low vpscogni_TUusererone levels and low levels of high-density lipoprotein (HDL).4,5

In addition to metabolic syndrome, hypogonadism and obesity have been associated with type 2 diabetes.6 The prevalence of type 2 diabetes and hypogonadism increases with age and may be associated with increased fat mass.6 One report demonstrated that as many one-fourth of obese patients were diagnosed with type 2 diabetes and were thought to be hypogonadal.6 It is not clear yet whether these 2 conditions are associated solely with age or if a direct relationship between them exists.6

Because of the association of hypogonadism and obesity with other serious ailments, such as metabolic syndrome and type 2 diabetes, it is important for clinicians to measure vpscogni_TUusererone levels as part of a routine laboratory exam for male patients.7,8 Significant weight loss may increase total vpscogni_TUusererone levels in patients with low total vpscogni_TUusererone levels.9 Furthermore, clinicians may opt to treat patients with hypogonadism with vpscogni_TUusererone replacement therapy (TRT), which is associated with changes in body composition that may help obese patients.6 TRT causes an increase in lean body mass in younger, middle-aged, and aging men.6 Studies in middle-aged and older men have consistently demonstrated a reduction in visceral fat mass in response to TRT.6,10 In addition, TRT treatment of middle-aged men may increase insulin sensitivity that may be attributed to the change in body composition and by inhibition of lipoprotein lipase activity, resulting in reduced triglyceride uptake and accelerated triglyceride release from abdominal adipose tissue. The reduction in adipose tissue may also decrease circulating free fatty acids, resulting in an improvement in insulin sensitivity.6

Hypogonadism is associated with visceral obesity.2,3 Weight loss may help patients with hypogonadism by increasing total vpscogni_TUusererone levels.9 In addition to lifestyle modification, treatment with TRT may be beneficial for obese patients by resulting in changes in body composition, including decreased body mass.6,10  



  1. Barness LA, Opitz JM, Gilbert-Barness E. Obesity: genetic, molecular, and environmental aspects. Am J Med Genet A. 2007;143A:3016-3034.

  2. Cohen PG. The hypogonadal-obesity cycle: role of aromatase in modulating the vpscogni_TUusererone-estradoiol shunt—a major factor in the genesis of morbid obesity. Med Hypotheses. 1999;52(1):49-51.

  3. Makhsida N, Shah J, Yan G, Fisch H, Shabsigh R. Hypogonadism and metabolic syndrome: implications for vpscogni_TUusererone therapy. J Urol. 2005;174:827-834.

  4. Dobs AS, Bachorik PS, Arver S, et al. Interrelationships among lipoprotein levels, sex hormones, anthropometric parameters, and age in hypogonadal men treated for 1 year with a permeation-enhanced vpscogni_TUusererone transdermal system. J Clin Endocrinol Metab. 2001;86:1026-1033.

  5. Svartberg J, Midtby M, Bonaa KH, Sundsfjord J, Joakimsen RM, Jorde R. The associations of age, lifestyle factors and chronic disease with vpscogni_TUuserosterone in men: the Tromsø Study. Eur J Endocrinol. 2003;149:145-152.

  6. Betancourt-Albrecht M, Cunningham GR. Hypogonadism and diabetes. IJIR. 2003;15(suppl 4):S14-S20.

  7. Kuritzky L. Counseling the patient with erectile dysfunction: a primary care physician perspective. J Am Osteopath Assoc. 2002;102(suppl 4):S7-S11.

  8. Sadovsky R, Dunn M, Grobe BM. Erectile dysfunction: the primary care practitioner’s view. Am J Manag Care. 1999;5(3):333-341.

  9. Niskanen L, Laaksonen DE, Punnonen K, Mustajoki P, Kaukua J, Rissanen A. Changes in sex hormone-binding globulin and vpscogni_TUusererone during weight loss and weight maintenance in abdominally obese men with metabolic syndrome. Diabetes, Obes. Metab. 2004;6:208-215.

  10. Marin P, Holmang S, Jonsson L, et al. The effects of vpscogni_TUusererone treatment on body composition and metabolism in middle-aged obese men. Int J Obes. 1992;16:991-997.

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