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 (cFT) testosterone, with normal/reduced gonadotropins.

Bariatric surgery often improves sex steroid and sex hormone binding globulin (SHBG) levels. Aim of the present study was to assess the effects of bariatric surgery on waist circumference (WC) and body mass index (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 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, waist circumference) and sex hormones (gonadotropins, TT, cFT, E2, SHBG) were assessed.

RESULTS: WC was the only parameter significantly correlated with androgens, but not with E2, SHBG and gonadotropins, at baseline. After surgery, a significant increase in TT, cFT and SHBG, accompanied by a decrease in estradiol (E2), was evident in the two groups. However, both TT and cFT, but not E2, SHBG and gonadotropin variations, were significantly higher in the hypogonadal group at follow-up, with an overall 93% complete recovery from HG. Reduction of WC, but not BMI, was significantly greater in hypogonadal men (ΔWC=-29.4±21.6 vs-14.4±17.4 at 12 months, P=0.047).

CONCLUSIONS: Recovery from obesity-associated hypogonadism is one of the beneficial effects of bariatric surgery in morbidly obese men. Present findings suggest that the gonadal state is a predictor of WC decrease after bariatric surgery.

Written by:
Samavat J, Facchiano E, Lucchese M, Forti G, Mannucci E, Maggi M, Luconi M.   Are you the author?
J Samavat, Dept. Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy; E Facchiano, Bariatric and Metabolic Unit, Azienda Ospedaliera-Universitaria Careggi, Florence, Italy; M Lucchese, Bariatric and Metabolic Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy; G Forti, Dept. Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy; E Mannucci, Diabetes Agency, Azienda Ospedaliera-Universitaria Careggi, Florence, Italy; M Maggi, Dept. Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy; M Luconi, Experimental & Clinical Medical Biosciences , University of Florence, florence, 50139, Italy.  

Reference: Eur J Endocrinol. 2014 Aug 12. pii: EJE-14-0596.
doi: 10.1530/EJE-14-0596


PubMed Abstract
PMID: 25117463

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