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. 2025 Apr 18.
doi: 10.1007/s42000-025-00656-0. Online ahead of print.

Exploring the role of hemodilution in the inverse association between obesity and testosterone concentrations in men

Shiwei Shen #  1 , Jingting Yun #  2 , Cheng Song #  2 , Yun Lu #  2 , Zhenhai Shen #  2 , Feng Li  3
Affiliations

Exploring the role of hemodilution in the inverse association between obesity and testosterone concentrations in men

Shiwei Shen et al. Hormones (Athens). .

Abstract

Purpose: This study aims to explore the inverse correlation between obesity and testosterone concentrations in men, with a particular focus on the role of hemodilution in this association. The research question addressed is whether hemodilution, due to increased plasma volume (PV), contributes to the lower testosterone concentrations observed in obese men.

Methods: We conducted a retrospective analysis using three datasets with sample sizes of 86, 134, and 446 participants, respectively. Multivariable linear regression models were used to examine the changes in PV, testosterone concentration, and mass across BMI categories, adjusting for age in each dataset and in the pooled data.

Results: The study demonstrated a significant inverse correlation between BMI groups and testosterone concentrations across the three datasets, as well as in the pooled data (beta coefficients: -0.024, -0.045, -0.040, -0.043; P < 0.001). Despite this, total testosterone mass remained stable (P > 0.05), suggesting that hemodilution, rather than a reduction in testosterone production, may account for the lower testosterone concentrations in obesity. Adjusted testosterone concentrations for obese participants were calculated using a formula that accounts for the increased PV.

Conclusion: Our findings suggest that hemodilution, associated with increased PV in obesity, is a significant factor contributing to the lower testosterone concentrations in obese men. This has implications for the diagnosis and treatment of testosterone deficiency in obesity and underscores the need for adjusted reference ranges. Further research is necessary to validate these findings and to explore their clinical implications.

Keywords: Hemodillution; Obesity; Testosterone.

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Conflict of interest statement

Declarations. Ethics approval: This study was approved by the Institutional Review Board of Taihu Rehabilitation Hospital of Jiangsu Province and was conducted in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. Informed consent: Given the retrospective nature of this study involving analysis of existing data, the requirement for informed consent was waived by the Institutional Review Board. The data were anonymized and de-identified prior to analysis to ensure confidentiality and protect the privacy of the individuals involved. Conflict of interest: The authors declare that they have no conflict of interest.

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