Data reported from three registries 23▪▪,59▪▪–61▪▪, in which long-term testosterone therapy was evaluated in men with testosterone deficiency and varying grades of obesity, suggested that testosterone therapy is effective in producing weight loss in all three grades of obesity. Testosterone therapy increases lean body mass and reduces total body fat mass in men with testosterone deficiency These findings represent strong foundations for testosterone therapy in obese men with testosterone deficiency and should spur clinical research for better understanding of usefulness of testosterone therapy in treatment of underlying pathophysiological conditions of obesity. The implication of testosterone therapy in management of obesity in men with testosterone deficiency is of paramount clinical significance, as it produces sustained weight loss without recidivism. Long-term testosterone therapy in men with testosterone deficiency produces significant and sustained weight loss, marked reduction in waist circumference and BMI and improvement in body composition. In some cases, medications like selective estrogen receptor modulators (SERMs) or aromatase inhibitors may be prescribed. Excessive alcohol consumption can negatively impact liver function, which is essential for estrogen metabolism. Some supplements, such as DIM (diindolylmethane) and chrysin, are often marketed as estrogen-blocking or estrogen-modulating agents. "We all have a keen interest in women's health, and we designed this together and ran it together," Varady said. It also improved A1C levels, a risk marker for diabetes, Varady said. Both groups also experienced a decrease in testosterone concentrations. However, some critics of intermittent fasting have posited that the diet disrupts female hormones, Varady said. The first line of treatment is typically hormonal birth control, said UIC professor of nutrition Krista Varady. Menstrual irregularity, obesity and even infertility can result. "Regardless of whether they qualify for medication or not, it’s important that men have a health care provider that they can discuss these concerns with," says Dr. Pearlman. Obesity is defined as having a body mass index (BMI) or 30 or higher. Plus, testosterone stops cells from maturing and storing more fat. In both females and males, testosterone increases sexual drive. The effects of testosterone therapy on increased LBM and reduced fat mass and the changes in anthropometric parameters were consistently reported in most studies 20–22,23▪▪,24–44,45▪,46▪▪,47–56,57▪,58▪▪–61▪▪,62▪,63▪,64–66, irrespective of testosterone formulations used or duration of testosterone treatment (Tables 1 and 2). Testosterone improves insulin sensitivity and reduces the c-reactive protein from the liver.30 During testosterone deficiency, which is a proinflammatory state, the increased fat mass leads to adipocyte dysfunction, resulting in a decrease in adiponectin and an increase in adipokines such as leptin, IL-1, IL-6, and TNF-α secreted from both adipocytes and activated macrophages.31 These adipokines further worsen the inflammation and induce a state of systemic insulin resistance.32 Moreover, adipokines cause hypogonadism by impairing kisspeptin signalling to reduce GnRH secretion.33,34 We propose that testosterone therapy in obese men with testosterone deficiency offers a well tolerated and effective therapy and produces sustained and significant weight loss. We suggest that testosterone therapy offers well tolerated and effective treatment of obesity in men with testosterone deficiency and this novel approach provides a unique opportunity to manage obese men. Further, long-term testosterone therapy in men with testosterone deficiency produced improvements in cardio-metabolic function, ameliorated MetS components, reduced fatigue, increased vigor and energy and improved quality of life 62▪,63▪,64–66,103▪▪,104–107,123. Testosterone regulates carbohydrates, proteins and fat metabolism 79,89 and testosterone therapy in men with testosterone deficiency results in normalization of glucose utilization and increased lipid oxidation .
