Changes in Testosterone Levels and Sex Hormone-Binding Globulin Levels in Extremely Obese Men after Bariatric Surgery Determinants of testosterone recovery after bariatric surgery: is it only a matter of reduction of body mass index? Sex hormones and sexual function in obese men losing weight. Circulating free testosterone in obese men after bariatric surgery increases in parallel with insulin sensitivity Resistance training increases SHBG in overweight/obese, young men. Testosterone replacement therapy restores normal ghrelin in hypogonadal men. Reduced-calorie dietary weight loss, exercise, and sex hormones in postmenopausal women: randomized controlled trial. Effects of transdermal testosterone on bone and muscle in older men with low bioavailable testosterone levels, low bone mass, and physical frailty. Weight loss is a major contributor to improved sexual function after bariatric surgery Diet and sex hormone-binding globulin. Effects of a supraphysiological dose of testosterone on physical function, muscle performance, mood, and fatigue in men with HIV-associated weight loss. The use of a transscrotal testosterone delivery system in the treatment of patients with weight loss related to human immunodeficiency virus infection. Sex hormone-binding globulin levels and cardiovascular risk factors in morbidly obese subjects before and after weight reduction induced by diet or malabsorptive surgery. The effects of injected testosterone dose and age on the conversion of testosterone to estradiol and dihydrotestosterone in young and older men. Anthropometric, computed tomography and fat cell data in an obese population: relationship with insulin, leptin, tumor necrosis factor-alpha, sex hormone-binding globulin and sex hormones. Erectile dysfunction and hormonal imbalance in morbidly obese male is reversed after gastric bypass surgery: a prospective randomized controlled trial. Effects of transdermal testosterone on bone and muscle in older men with low bioavailable testosterone levels.
Objective . Obesity is a risk factor for hypogonadotropic hypogonadism in men . Weight loss has been shown to improve hypogonadism in obese men . This study evaluated the early changes in sex hormones profile after bariatric surgery . Methods . This is a prospect i ve study including 29 morbidly obese men . Main outcomes were changes in serum levels of total testosterone ( TT ) , free testosterone ( cFT ) , SHBG , estradiol , adiponectin , and leptin at 1 and 6 months after surgery . Results . The mean age of patients was 31 ± 8 years and the mean BMI was 56.8 ± 11.7 kg/m2 . Fifteen patients underwent Roux-en-Y gastric bypass and 14 patients underwent sleeve gastrectomy .  At baseline , 22 patients ( 75.9 % ) had either low TT levels ( < 10.4 nmol/L ) or low cFT levels ( < 225 pmol/L ) . Total testosterone and SHBG levels increased significantly at 1 month after surgery ( p ≤ 0.001 ) . At 6 months after surgery , TT and cFT increased significantly ( p ≤ 0.001 ) and 22 patients ( 75.9 % ) had normalized TT and cFT levels . There were no changes in estradiol levels at either 1 month or 6 months after surgery . Conclusions . Increases in TT and SHBG levels occurred early at 1 month after bariatric surgery while improvements in cFT levels were observed at 6 months after bariatric surgery OBJECTIVE To explore the correlation models between body mass index ( BMI ) and sex hormones constructed from a male cross-sectional survey and evaluate the effects of surgery-induced weight loss on sex hormones in morbidly obese subjects that are not predicted by the constructed BMI correlation models . DESIGN Cross-sectional population and longitudinal studies . SETTING Bariatric surgery center in a university hospital . PATIENT(S ) A cross-sectional survey of a male general population of 161 patients ( BMI median [ interquartile range ] = 29.2 [ 24.8 - 41.9 ] kg/m(2 ) ) in addition to 24 morbidly obese subjects ( BMI = 43.9 [ 40.8 - 53.8 ] kg/m(2 ) ) who were undergoing bariatric surgery  were prospect ively studied for 6 and 12 months . INTERVENTION(S )  Bariatric surgery on 24 morbidly obese men . MAIN OUTCOME MEASURE(S ) Cross-sectional population : construction of the best-fitting models describing the relationship between baseline BMI with total ( TT ) and calculated free ( cFT ) testosterone , E2 , sex hormone-binding globulin ( SHBG ) , FSH , and LH levels . Longitudinal study deviation between the observed sex hormone levels at 6- and 12-month follow-up and those expected on BMI bases . RESULT ( S ) The correlation of BMI with sex hormones was not univocally linear ( E2 ) , but the best-fitting model was exponential for TT , cFT , FSH , LH , and TT/E2 and power for SHBG . In addition to the significant improvement of all parameters observed after surgery in the longitudinal cohort , the increase in TT and SHBG , but not in cFT , was significantly higher than expected from the corresponding weight loss at 6 months from surgery ( 14.80 [ 12.30 - 19.00 ] nM vs. 12.77 [ 10.92 - 13.64 ] nM and 40.0 [ 28.9 - 54.5 ] nM vs. 24.7 [ 22.5 - 25.8 ] nM for TT and SHBG , respectively ) , remaining rather stable at 12 months . CONCLUSION ( S ) The increase in TT and SHBG , but not the increase in cFT , after bariatric surgery is greater than expected based on weight loss OBJECTIVE To study the impact of a weight-loss program on sex hormones and sexual function among 38 middle-aged obese men ( BMI > or=35 kg/m(2 ) ) . RESEARCH METHODS AND PROCEDURES A r and omized controlled clinical trial was conducted . The treatment group ( n = 19 ) participated in a 4-month weight-loss program including 10 weeks on a very-low-energy diet ( VLED ) and 17 behavior modification visits . There was no intervention in the control  group ( n = 19 ) . Both groups were followed for 8 months , i.e. , 22 weeks after the active weight loss in the treatment group . The outcome measures ( weight , sex hormones , sexual function , leptin , and metabolic variables ) were obtained at baseline and at three time-points during follow-up . RESULTS The mean weight loss in the treatment group was 21 kg at the end of the 10-week VLED . At the end of follow-up , the maintained weight loss was 17 kg of baseline weight . The control group was weight stable throughout the study . In the treatment group , increases in sex hormone-binding globulin , testosterone , and high-density lipoprotein-cholesterol , as well as decreases in insulin and leptin , were maintained until the end of follow-up , although with VLED , the level of several hormones and metabolic variables improved transiently during the rapid weight loss . There were no significant changes in the question naire scores on sexual function in either group . DISCUSSION We conclude that obese men lose weight and increase their serum testosterone level on a weight-loss program with VLED and behavior modification . However , they do not change their sexual function scores Background and aim : Male hypogonadism has been linked to obesity and diabetes . We aim ed to study the association of changes in insulin sensitivity and testosterone levels in severe obese patients su bmi tted to bariatric surgery .  Subjects and methods : Prospect i ve intervention study with twenty consecutive patients who underwent bariatric surgery studied before and after significant weight loss .  Serum testosterone , SHBG , fasting glucose , and insulin were measured among others . Free testosterone was calculated with the Vermeulen formula and insulin sensitivity with the homeostatic model assessment ( HOMA ) . Results : At baseline , thirteen patients had low total testosterone levels  , whereas eight of these patients also had free testosterone levels below the reference range obtained from the control group . After bariatric surgery  total testosterone , SHBG , and free testosterone significantly increased and achieved normal values in all evaluated patients . Insulin sensitivity improved in all of them . Multivariate linear regression showed that changes in fasting glucose ( β=−1.868 , p= 0.001 ) , insulin ( β=−3.782 , p= 0.001 ) , weight ( β=−0.622 , p= 0.002 ) , and SHBG ( β=−0.635 , p= 0.022 ) were associated with changes in free testosterone ( adjusted R2 = 0.936 , F=26.613 , p= 0.001 ) . When insulin resistance calculated by HOMA was in the model instead of insulin and glucose , it also was associated ( β=−3.488 , p= 0.008 ) with free testosterone ( adjusted R2 = 0.821 , F=11.111 , p= 0.005 ) . Conclusion : Circulating testosterone in obese men increases after bariatric surgery in parallel with an improvement in insulin sensitivity OBJECTIVE Evidence suggests that SHBG affects glycemic control , predicts both T2D and metabolic syndrome , and is low in obese subjects . We sought to determine if resistance exercise training ( RT ) can increase sex hormone-binding globulin ( SHBG ) and ameliorate levels of related steroid hormones in overweight/obese , sedentary young men . MATERIAL S/ METHODS 36 participants ( BMI 31.4 kg/m(2 ) , age 22 years ) were r and omized into an RT ( 12 weeks of training , 3/week ) or control group ( C , 12 weeks no training ) , and assessed for changes in SHBG , cortisol , testosterone , free testosterone ( FT ) and free and rogen index ( FAI ) . In addition , body composition and oral glucose tolerance testing was performed . RESULTS 12 weeks of RT  increased SHBG ( P=0.01 ) and decreased FAI ( P<0.05 ) and cortisol ( P<0.05 ) compared to C. FT decreased in RT ( P=0.01 ) . Total testosterone did not change in either group . These changes were noted without weight loss , and in concert with increases in lean body mass ( P=0.0002 vs C ) and decreases in glucose area under the curve ( AUC ) ( P=0.004 ) , insulin AUC ( P=0.03 ) , and total ( P=0.002 ) and trunk ( P=0.003 ) fat mass in RT . CONCLUSION In overweight/obese young men , RT increases SHBG and lowers FAI in obese young adult men We recently described a connection between and rogens and ghrelin in women affected by the polycystic ovary syndrome . To further investigate the interaction between sex steroids and ghrelin , we investigated  circulating ghrelin levels  in a group of hypogonadal men before and after therapeutic intervention aim ing at normalization low testosterone ( T ) concentrations . Seven hypogonadal men were compared with nine overweight/moderately obese men matched for body mass index and body fat distribution parameters , as well as with 10 normal weight controls .  Total and free T and plasma ghrelin levels were significantly lower in the hypogonadal men than in the control groups . Hypogonadal men also had a significantly higher insulin resistance state . Ghrelin levels were positively correlated with both total and free T concentrations . A significant correlation was also found between ghrelin and the anthropometric parameters and the insulin resistance indexes . However , in a multiple regression analysis in which a correction for all covariants was performed , only the relationship with total and free T persisted . After the 6-month replacement T therapy , ghrelin levels of hypogonadal patients increased and did not differ significantly in comparison with both control groups . The positive correlation between ghrelin and and rogens still persisted after T replacement therapy , after adjusting for confounding variables . These data further indicate that sex hormones modulate circulating ghrelin concentrations in humans . This may be consistent with the concept that ghrelin may exert a relevant role in the endocrine network connecting the control of the reproductive system with the regulation of energy balance PURPOSE Estrogens and and rogens are elevated in obesity and associated with increased postmenopausal breast cancer risk , but the effect of weight loss on these biomarkers is unknown . We evaluated the individual and combined effects of a reduced-calorie weight loss diet and exercise on serum sex hormones in overweight and obese postmenopausal women . PATIENTS AND METHODS We conducted a single-blind , 12-month , r and omized controlled trial from 2005 to 2009 . Participants ( age 50 to 75 years ; body mass index > 25.0 kg/m(2 ) , exercising < 100 minutes/wk ) were r and omly assigned using a computer-generated sequence to ( 1 ) reduced-calorie weight loss diet ( " diet " ; n = 118 ) , ( 2 ) moderate- to vigorous-intensity aerobic exercise ( " exercise " ; n = 117 ) , ( 3 ) combined reduced-calorie weight loss diet and moderate- to vigorous-intensity aerobic exercise ( " diet + exercise " ; n = 117 ) , or ( 4 ) control ( n = 87 ) . Outcomes were estrone concentration ( primary ) and estradiol , free estradiol , total testosterone , free testosterone , and rostenedione , and sex hormone-binding globulin ( SHBG ) concentrations ( secondary ) . RESULTS Mean age and body mass index were 58 years and 30.9 kg/m(2 ) , respectively . Compared with controls , estrone decreased 9.6 % ( P = .001 ) with diet , 5.5 % ( P = .01 ) with exercise , and 11.1 % ( P < .001 ) with diet + exercise . Estradiol decreased 16.2 % ( P < .001 ) with diet , 4.9 % ( P = .10 ) with exercise , and 20.3 % ( P < .001 ) with diet + exercise . SHBG increased 22.4 % ( P < .001 ) with diet and 25.8 % ( P < .001 ) with diet + exercise . Free estradiol decreased 21.4 % ( P < .001 ) with diet and 26.0 % ( P < .001 ) with diet + exercise . Free testosterone decreased 10.0 % ( P < .001 ) with diet and 15.6 % ( P < .001 ) with diet + exercise . Greater weight loss produced stronger effects on estrogens and SHBG . CONCLUSION Weight loss significantly lowered serum estrogens and free testosterone , supporting weight loss for risk reduction through lowering exposure to breast cancer biomarkers OBJECTIVES To investigate the effects of testosterone supplementation on bone , body composition , muscle , physical function , and safety in older men . DESIGN Double-blind , r and omized , placebo-controlled trial . SETTING A major medical institution . PARTICIPANTS One hundred thirty-one men ( mean age 77.1 + /- 7.6 ) with low testosterone , history of fracture , or bone mineral density ( BMD ) T-score less than -2.0 and frailty . INTERVENTION Participants received 5 mg/d of testosterone or placebo for 12 to 24 months ; all received calcium ( 1500 mg/d diet and supplement ) and cholecalciferol ( 1,000 IU/d ) . MEASUREMENTS BMD of hip , lumbar spine , and mid-radius ; body composition ; sex hormones , calcium-regulating hormones ; bone turnover markers ; strength ; physical performance ; and safety parameters . RESULTS Ninety-nine men ( 75.6 % ) completed 12 months , and 62 ( 47.3 % ) completed end therapy ( mean 23 months ; range 16 - 24 months for 62 who completed therapy ) . Study adherence was 54 % , with 40 % of subjects maintaining 70 % or greater adherence . Testosterone and bioavailable testosterone levels at 12 months were 583 ng/dL and 157 ng/dL , respectively , in the treatment group . BMD on testosterone  increased 1.4 % at the femoral neck and 3.2 % at the lumbar spine ( P=.005 ) and decreased 1.3 % at the mid-radius ( P<.001 ) . There was an increase in lean mass and a decrease in fat mass in the testosterone group but no differences in strength or physical performance . There were no differences in safety parameters . CONCLUSION Older , frail men receiving  testosterone replacement increased testosterone levels and had favorable changes in body composition , modest changes in axial BMD , and no substantial changes in physical function Background The relative contribution of anthropometric , hormonal , and metabolic changes after  bariatric surgery ( BS ) on sexual function ( SF ) in severely obese subjects is not well established . Methods Prospect i ve observational case series study of 39 men undergoing BS .  SF was assessed by means of the international index of erectile function ( IIEF ) before and at 1 year after surgery . At the same time points , anthropometric ( body mass index , waist circumference ) , hormonal ( testosterone , sex hormone binding globulin , estradiol , gonadotropins , inhibin B , prolactin , leptin ) , and metabolic parameters ( insulin sensitivity , C-reactive protein , lipid profile , hemoglobin A1c , presence of hypertension or sleep apnea ) were assessed . Results BS was associated with marked weight loss ( 77.18 % excess weight loss ) , improved IIEF score ( baseline : 54.85 ± 16.59 , 1 year : 61.21 ± 14.10 ; p < 0.01 ) , gonadal function ( testosterone : baseline 256.36 ± 120.98 , 1 year : 508.01 ± 161.90 ; p < 0.001 ) , and improved metabolic profile . However , on multivariate regression analysis whereas changes in body mass index ( beta : −0.677 , p = 0.001 ) , and baseline IIEF score ( beta : −0.397 , p = 0.023 ) , were independent predictors of the changes in the IIEF score at 1 year after surgery , changes in hormonal and metabolic factors were not . Variables in the model accounted for 66 % of the postsurgical variation in the IIEF score . Similar results were found when the different IIEF-sexual domains were evaluated , except for intercourse satisfaction for which no independent predictor was identified . Conclusions Weight loss ’s beneficial effects on SF occurring after BS are beyond the parallel improvement in gonadal and metabolic profiles The serum concentration of sex hormone-binding globulin ( SHBG ) is inversely related to weight and in animal studies is inversely related to protein intake . As SHBG can affect the biological activity of testosterone and estradiol , we wished to determine the role of protein intake on SHBG levels in men . Using data from the Massachusetts Male Aging Study we examined cross-sectional relationships between dietary components and SHBG levels in 1552 men ( aged 40 - 70 yr ) for whom these factors were known . Analyzed by multiple regression , controlling for testosterone and estradiol levels , age ( P<0.001 ) and fiber intake ( P = 0.02 ) were positively correlated to SHBG concentration , whereas body mass index ( P<0.001 ) and protein intake ( P<0.03 ) were negatively correlated to SHBG concentration . The intakes of calories , fat ( animal or vegetable ) , and carbohydrate were not related to SHBG concentration . We conclude that age and body mass index are major determinants of SHBG concentrations in older men , and fiber and protein intake are also significant contributors to SHBG levels , but total caloric intake and the intake of carbohydrate or fat are not significant . Thus , diets low in protein in elderly men may lead to elevated SHBG levels and decreased testosterone bioactivity . The decrease in bioavailable testosterone can then result in declines in sexual function and muscle and red cell mass , and contribute to the loss of bone density Testosterone increases fat-free mass ( FFM ) in men infected with human immunodeficiency virus ( HIV ) , but its effects on muscle performance , physical function , mood , and quality of life are poorly understood . Sixty-one HIV-infected men with weight loss were r and omized to receive weekly intramuscular injections of 300 mg of testosterone enanthate or placebo for 16 wk . The primary outcome of interest was physical function ( walking speed , stair-climbing power , and load-carrying ability ) . Secondary outcome measures included body weight and composition , muscle performance , sexual function , mood , and quality of life . Serum nadir free and total testosterone levels increased ( + 188.0 + /- 29.6 and + 720 + /- 86 ng/dl ) in the testosterone , but not placebo , group . Testosterone administration was associated with increased FFM ( 2.8 + /- 0.5 kg ) , which was significantly greater than in the placebo group ( P < 0.0001 ) . Leg press strength increased significantly in testosterone-treated ( P = 0.027 ) , but not placebo-treated , men ; the difference between groups was not significant . Other measures of muscle performance and physical function did not change significantly in either group . Men receiving testosterone demonstrated significantly greater improvements in mental health and quality -of-life scores than those receiving placebo and improvements in fatigue/energy and mood scores that were not significantly different from those receiving placebo .  Sexual function scores did not change in either group . In HIV-infected men with weight loss , a supraphysiological dose of testosterone significantly increased FFM but did not improve self-reported or performance-based measures of physical function . Improvements in mood , fatigue , and quality -of-life measures in the testosterone group , although clinical ly important , need further confirmation PURPOSE Weight loss is a strong predictor of morbidity and mortality in human immunodeficiency virus (HIV)-infected patients . Men with acquired immunodeficiency syndrome ( AIDS ) lose body cell mass . Hypogonadism is also common . This study tested the efficacy of a testosterone transscrotal patch ( 6 mg/day ) in improving body cell mass and treating hypogonadism in these patients . SUBJECTS AND METHODS This multicenter , r and omized , double-blinded , placebo-controlled trial was conducted from August 1995 to October 1996 in 133 men , 18 years of age and older , who had AIDS , 5 % to 20 % weight loss , and either a low morning serum total testosterone level ( < 400 ng/dL ) or a low free testosterone level ( < 16 pg/mL ) . Outcomes included weight , body cell mass as measured using bioelectrical impedance analysis , quality of life , and morning measurements of serum testosterone and dihydrotestosterone levels , lymphocyte subsets , and HIV quantification . RESULTS There were no significant differences in baseline weight , CD4 cell counts , or HIV serum viral quantification between treatment arms . Morning total and free testosterone levels increased in those treated with testosterone , but not with placebo . Following 12 weeks of treatment there were no differences ( testosterone-placebo ) in mean weight change ( -0.3 kg [ 95 % confidence interval ( CI ) : -1.4 to 0.8 ] ) or body cell mass ( -0.2 kg [ 95 % CI : -1.0 to 0.6 ] ) in the two groups . There were also no changes in quality of life in either group . CONCLUSION Hypogonadal men with AIDS and weight loss can achieve adequate morning serum sex hormone levels using a transscrotal testosterone patch . However , this system of replacement does not improve weight , body cell mass , or quality of life One of the main goals of weight reduction in morbidly obese subjects is its benefit on coronary heart disease ( CHD ) risk . A cross-sectional study was design ed to r and omly assign 79 morbidly obese subjects ( 27 men and 52 women ; age : 30 - 45 years ) either to a diet protocol ( 20 kcal per kg fat-free mass ( FFM ) ; 55 % carbohydrates , 30 % fat , and 15 % proteins ) or to malabsorptive surgery ( biliopancreatic diversion ) .  Fatness parameters , measured by dual-energy X-ray absorptiometry , lipid profile , insulin , leptin , sex steroid hormones and sex hormone-binding globulin ( SHBG ) levels were compared at baseline and 1 year after the beginning of the study . The data showed that plasma SHBG levels , but not testosterone levels , correlated negatively to fasting insulin levels and positively to HDL-cholesterol in both men and women . Total leptin levels were significantly lower ( P<0.0001 ) in post-BPD subjects of both sexes compared to dietary treated obese subjects . The logarithm of plasma leptin correlated significantly and positively with insulin but negatively with SHBG.A step-down regression analysis showed that FFM and SHBG , but not insulin levels , were the most powerful independent variables for predicting HDL-cholesterol levels in morbidly obese patients . The negative relationship between SHBG levels and CHD risk appears to be mediated by a concomitant variation in body fatness . Finally , in obese patients , SHBG levels seem to be an indicator of total adiposity rather than an index of an altered insulin/glucose homeostasis BACKGROUND During testosterone ( T ) therapy , T is partly converted to 17beta-estradiol ( E2 ) and 5alpha-dihydrotestosterone ( DHT ) . Effects of age , testosterone dose , and body composition on total and free E2 and DHT levels are unknown . OBJECTIVE We evaluated age and dose-related differences in E2 and DHT levels in response to grade d doses of testosterone enanthate in young and older men . METHODS Fifty-one young ( aged 19 - 35 yr ) and 52 older ( aged 59 - 75 yr ) men completed treatment with monthly injections of a GnRH agonist plus r and omly assigned weekly doses of testosterone enanthate ( 25 , 50 , 125 , 300 , or 600 mg ) for 5 months . RESULTS During testosterone administration , total and free E2 levels increased dose-dependently ( dose effect , P<0.001 ) in both young and older men . Total and free E2 levels and E2:T ratios during T administration were higher in older than young men , but age-related differences in free E2 and free E2:T ratios were not significant after adjusting for testosterone levels , percentage fat mass , and SHBG . DHT levels and DHT : T ratios were dose-related but did not differ between young and older men . Mechanistic modeling of free hormone data revealed that the conversions of T to E2 and DHT were both consistent with saturable Michaelis-Menten kinetics . The in vivo Km values were estimated to be 1.83 nm for aromatase and 3.35 nm for 5alpha-reductase , independent of age . The Vmax parameter for E2 was 40 % higher in older men than younger men , but Vmax for DHT was not significantly different between age groups . CONCLUSIONS During i m testosterone administration , E2 and DHT levels exhibit saturable increases with dose . The rate of whole body aromatization is higher in older men , partly related to their higher percentage fat mass , SHBG , and testosterone levels OBJECTIVE To correlate anthropometric , computed tomography and fat cell data from abdominal regions with the levels of serum insulin , C-peptide , leptin , tumor necrosis factor-alpha ( TNF-alpha ) , testosterone , 17beta-estradiol , and rostenedione , dehydroepi and rosterone sulphate ( DHEA-S ) and sex hormone-binding globulin ( SHBG ) . DESIGN AND METHODS The sample consisted of 84 obese patients ( 29 men , 22 premenopausal women and 33 postmenopausal women ) who had undergone abdominal surgery .  Weight , height , percentage of body fat by skinfolds , waist , hip and thigh circumferences , sagittal and coronal diameters , visceral and subcutaneous area , serum hormones and fat cell data were studied . RESULTS AND CONCLUSIONS Premenopausal women showed the lowest values in most abdominal distribution parameters , although , depending on the waist circumference criteria at the umbilicus level perimeter ( W1 ) or midway between lower rib margin and iliac crest perimeter ( W2 ) , the population was classified differently , as gynoid or and roid . Although there were no differences in fat cell size between genders , gynoid women had smaller and more numerous fat cells than the and roid type . Perivisceral fat cell size was significantly smaller than subcutaneous fat cell size . In women , central obesity was significantly correlated with an increase in serum insulin , leptin , TNF-alpha , testosterone and and rostenedione levels , and a decrease in 17beta-estradiol and DHEA-S , while in men significant correlations were positive with insulin and negative with testosterone and and rostenedione . Fat cell size was positively correlated with serum levels of leptin , insulin , DHEA-S , and rostenedione and inversely correlated with SHBG . These data indicate that hormones seem to interact not only with body fat distribution but also with fat cell size . This interaction differs between genders and between the different abdominal adipose tissue regions The effects of weight loss on erectile function and hormones have not been well studied . The aim of this study was to measure the degree to which sexual function and in particular erectile function and hormonal environment change after substantial weight loss , surgically and non-surgically induced in the morbidly obese male in a prospect i ve r and omized long-term controlled trial . Furthermore , how surgery makes a difference when treating morbidly obese men was envisaged in this context . We prospect ively studied 20 morbidly obese men for 24 months , divided into two groups : group  A  included 10 patients who underwent life style modifications ( exercise and diet ) for 4 months and subsequently gastric bypass , and another 10 patients in group B were kept on weekly follow-up . None of the men were taking phosphodiesterase type-5 inhibitors . All patients underwent International Index of Erectile Function (IIEF)-5 question naire , serum oestradiol , prolactin ( PRL ) , luteinizing ( LH ) and follicle-stimulating ( FSH ) hormones , free and total testosterone ( FT and TT ) at baseline ( time 0 ) , surgery - 4 months latter baseline ( time 1 ) and final evaluation - 24 months ( time 2 ) . From times 0 to 1 , group A presented a mean body mass index ( BMI ) reduction of 12.6 ( p < 0.0001 ) , whereas group B , 2.1 ( p > 0.05 ) . The BMI reductions between times 0 and 2 were 24.7 ( p < 0.0001 ) and 0.7 ( p > 0.05 ) for groups A and B respectively . BMI average between the two groups was similar at time 0 ( p = 0.2142 ) , and different at times 1 ( p = 0.0033 ) and 2 ( p < 0.0006 ) . Increase in IIEF-5 score ( p = 0.0469 ) , TT ( p = 0.0349 ) and FSH levels ( p = 0.0025 ) , and reduction in PRL level ( p < 0.0001 ) were observed in group A from times 0 to 2 and 1 to 2 . There were no changes from times 0 to 1 . Comparing groups A and B at time 2 , IIEF-5 , TT and FT increased significantly in group A ( p = 0.0224 , 0.0043 and 0.0149 respectively ) . Surgery-induced weight loss increased erectile function quality measured by IIEF-5 question naire , increased TT , FT and FSH and reduced PRL levels . The hormonal impact verified could justify the improvement in erectile function .  Lifestyle modifications impacted BMI without hormonal or sexual impact in morbidly obese . New studies are warranted in the field to support our data BACKGROUND A large proportion of men over 65 years of age have bioavailable testosterone levels below the reference range of young adult men . The impact of this on musculoskeletal health and the potential for improvement in function in this group with testosterone supplementation require investigation . METHODS Sixty-seven men ( mean age 76 + /- 4 years , range 65 - -87 ) with bioavailable testosterone levels below 4.44 nmol/l ( lower limit for adult normal range ) were r and omized to receive transdermal testosterone  ( two 2.5-mg patches per day ) or placebo patches for 1 year . All men received 500 mg supplemental calcium and 400 IU vitamin D. Outcome measures included sex hormones ( testosterone , bioavailable testosterone , sex-hormone binding globulin [ SHBG ] , estradiol , and estrone ) , bone mineral density ( BMD ; femoral neck , Ward 's triangle , trochanter , lumbar spine , and total body ) , bone turnover markers , lower extremity muscle strength , percent body fat , lean body mass , hemoglobin , hematocrit , prostate symptoms , and prostate specific antigen ( PSA ) levels . RESULTS Twenty-three men ( 34 % ) withdrew from the study ; 44 men completed the trial . In these men , bioavailable testosterone levels increased from 3.2 + /- 1.2 nmol/l ( SD ) to 5.6 + /- 3.5 nmol/l ( p < .002 ) at 12 months in the testosterone group , whereas no change occurred in the control group . Although there was no change in estradiol levels in either group , estrone levels increased in the testosterone group ( 103 + /- 26 pmol/l to 117 + /- 33 pmol/l ; p < .017 ) . The testosterone group had a 0.3 % gain in femoral neck BMD , whereas the control group lost 1.6 % over 12 months ( p = .015 ) . No significant changes were seen in markers of bone turnover in either group . Improvements in muscle strength were seen in both groups at 12 months compared with baseline scores . Strength increased 38 % ( p = .017 ) in the testosterone group and 27 % in the control group ( p = .06 ) , with no statistical difference between the groups . In the testosterone group , body fat decreased from 26.3 + /- 5.8 % to 24.6 + /- 6.5 % ( p = .001 ) , and lean body mass increased from 56.2 + /- 5.3 kg to 57.2 + /- 5.1 kg ( p = .001 ) , whereas body mass did not change . Men receiving testosterone had an increase in PSA from 2.0 + /- 1.4 microg/l to 2.6 + /- 1.8 microg/l ( p = .04 ) , whereas men receiving placebo had an increase in PSA from 1.9 + /- 1.0 microg/l to 2.2 + /- 1.5 microg/l ( p = .09 ) . No significant differences between groups were seen in hemoglobin , hematocrit , symptoms or signs of benign prostate hyperplasia , or PSA levels . CONCLUSIONS Transdermal testosterone ( 5 mg/d ) prevented bone loss at the femoral neck , decreased body fat , and increased lean body mass in a group of healthy men over age 65 with low bioavailable testosterone levels . In addition , both testosterone and placebo groups demonstrated gains in lower extremity muscle strength , possibly due to the beneficial effects of vitamin D. Testosterone did result in a modest increase in PSA levels but result ed in no change in signs or symptoms of prostate hyperplasia
And rogen rise is greater in those patients who lose more weight as well as in younger , non-diabetic subjects with a greater degree of obesity .
Body weight loss is also associated with a decrease in estradiol and an increase in gonadotropins levels .
These data show that weight loss is associated with an increase in both bound and unbound testosterone levels .
The normalization of sex hormones induced by body weight loss is a possible mechanism contributing to the beneficial effects of surgery in morbid obesity
OBJECTIVE Few r and omized clinical studies have evaluated the impact of diet and physical activity on testosterone levels in obese men with conflicting results .
Conversely , studies on bariatric surgery in men generally have shown an increase in testosterone levels .
The aim of this study is to perform a systematic review and meta- analysis of available trials on the effect of body weight loss on sex hormones levels .