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Review
. 2022 Dec;23(6):1233-1242.
doi: 10.1007/s11154-022-09746-5. Epub 2022 Jul 14.

Obesity, type 2 diabetes, and testosterone in ageing men

Gary Wittert  1   2   3 , Mathis Grossmann  4   5
Affiliations
Review

Obesity, type 2 diabetes, and testosterone in ageing men

Gary Wittert et al. Rev Endocr Metab Disord. 2022 Dec.

Abstract

In the absence of obesity, adverse lifestyle behaviours, and use of medication such as opioids serum testosterone concentrations decrease by only a minimal amount at least until very advanced age in most men. Obesity is heterogeneous in its phenotype, and it is the accumulation of excess adipose tissue viscerally associated with insulin resistance, dyslipidaemia, inflammation, hypothalamic leptin resistance and gliosis that underpins the functional hypogonadism of obesity. Both central (hypothalamic) and peripheral mechanisms are involved resulting in a low serum total testosterone concentration, while LH and FSH are typically in the normal range. Peripherally a decrease in serum sex hormone binding globulin (SHBG) concentration only partially explains the decrease in testosterone and there is increasing evidence for direct effects in the testis. Men with obesity associated functional hypogonadism and serum testosterone concentrations below 16 nmol/L are at increased risk of incident type 2 diabetes (T2D); high testosterone concentrations are protective. The magnitude of weight loss is linearly associated with an increase in serum testosterone concentration and with the likelihood of preventing T2D or reverting newly diagnosed disease; treatment with testosterone for 2 years increases the probability of a positive outcome from a lifestyle intervention alone by approximately 40%. Whether the additional favourable benefits of testosterone treatment on muscle mass and strength and bone density and quality in the long-term remains to be determined.

Keywords: Ageing; Men; Obesity; Testosterone; Type 2 diabetes.

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Conflict of interest statement

GW has received research support from Bayer, Lawley Pharmaceuticals and Eli Lilly. Honoraria for participation in advisory boards have been received from Bayer and Elsevier, Speaker fees have been received from Bayer and Besins Health Care. MG has received research funding from Bayer and Otsuka. He has received fees for advisory board participation form Bayer and Otsuka, and speaker fees from Bayer, Besins Health Care and Novartis. This is a review. There is no requirement for ethical approval. To the best of my knowledge the studies cited have had appropriate ethics approval. This is a review. To the best of my knowledge the studies cited have obtained informed consent. Relative contributions of the Authors to this work: GW 80%, MG 20%.

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