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15 January 2017

AACE and ACE Clinical Practice Guidelines on Obesity Call for Testosterone Testing and Treatment

AACE and ACE Clinical Practice Guidelines on Obesity Call for Testosterone Testing and Treatment

American Association of Clinical Endocrinologists and American College of Endocrinology Clinical Practice Guidelines for Comprehensive Medical Care of Patients with Obesity, 2016.

The combined prevalence of overweight and obesity is 71% in adults, and up to 50 - 80% of obese men have testosterone deficiency (also known as hypogonadism). The most common comorbidity among the growing obese population is type 2 diabetes; about half of all men with type 2 diabetes have hypogonadism.

Recent clinical guidelines on hypogonadism state that increased visceral (also known as intra-abdominal) body fat and obesity are signs of hypogonadism, and that testosterone should be assessed in men with obesity, metabolic syndrome and diabetes. However, due to the epidemic prevalence of overweight/obesity and related metabolic diseases, the large majority of hypogonadal men will see a primary care physician and/or a diabetologist or cardiologist, who is likely not aware of the clinical guidelines on hypogonadism.

It is therefore laudable that The American Association of Clinical Endocrinologists (AACE) and American College of Endocrinology (ACE) Clinical Practice Guidelines for Comprehensive Medical Care of Patients with Obesity in their 2016 revision dedicated two comprehensive sections on testosterone deficiency and treatment. Here we summarize these AACE / ACE recommendations.

Key Points

  • All men who have an increased waist circumference (≥102 cm) or who have obesity (BMI ≥30 kg/m²) should be assessed for hypogonadism by history and physical examination and be tested for testosterone deficiency; all men with hypogonadism should be evaluated for the presence of overweight or obesity.
  • All men with type 2 diabetes should be tested to exclude testosterone deficiency.
  • Treatment of hypogonadism in men with increased waist circumference or obesity should include weight-loss therapy. Weight loss of more than 5 to 10% is needed for significant improvement in serum testosterone.
  • Men with hypogonadism and obesity who are not seeking fertility should be considered for testosterone therapy in addition to lifestyle intervention, since testosterone in these patients results in weight loss, decreased waist circumference, and improvements in metabolic parameters glucose, HbA1C, lipids, and blood pressure).

15 January 2016

Testosterone Therapy Reduces Insulin Resistance and Inflammation in Men with Type 2 Diabetes

Testosterone Therapy Reduces Insulin Resistance and Inflammation in Men with Type 2 Diabetes

Insulin Resistance and Inflammation in Hypogonadotropic Hypogonadism and Their Reduction After Testosterone Replacement in Men With Type 2 Diabetes.
Dhindsa S, Ghanim H, Batra M, et al. Diabetes Care. 2016;39(1):82-91.

Testosterone deficiency – defined as low levels of total testosterone in the presence of symptoms - is common among men with obesity and type 2 diabetes, with a reported prevalence of 58% and 45%, respectively. However, even after adjusting for age and BMI (a surrogate measure for obesity), the prevalence of subnormal free testosterone levels in men with type 2 diabetes is higher than in men without.

Insulin resistance occurs when the body’s cells become insensitive to the insulin, which is a hormone that is necessary for transport of blood sugar (glucose) into cells. To compensate for the resistance to insulin, the pancreas increases insulin production up to the point until the pancreas’ capability to produce insulin is exhausted.

Here we summarize the results of a study conducted by a research team at the Division of Endocrinology, Diabetes and Metabolism, State University of New York. This study specifically selected men with type 2 diabetes based on low free testosterone levels. The aims of the study were to investigate:

1) The impact of testosterone deficiency on insulin resistance, inflammation, and body composition in men with type 2 diabetes.

2) The effects of intramuscular testosterone replacement on insulin sensitivity, inflammation, and body composition.

20 August 2013

Obesity is strongly linked to low testosterone levels in men

Obesity is strongly linked to low testosterone levels in men
This summary gives an overview of four research papers which discuss the link between obesity and low testosterone levels (also known as hypogonadism): one review focusing on the association between obesity, diabetes and low testosterone, and three clinical studies. The studies looked at the relationship between body mass index (BMI) and testosterone levels in men, and the effects of weight loss on testosterone levels in a group of very obese men (BMI >40 kg/m2) undergoing weight loss surgery; the link between obesity and testosterone levels in young men aged 14-20 years; and the relationship between health and lifestyle factors, including weight loss, and testosterone levels in men as they get older.

21 May 2012

Evidence of a key role for testosterone in the cause and treatment of obesity, the metabolic syndrome and diabetes

Image: overweighted man
The rapid increase in rates of obesity in both the developed and the developing world has serious consequences. Nearly all obese adults suffer from at least one obesity-related disease, such as type 2 diabetes, high blood pressure, cardiovascular disease, cancer, or joint disorders. A recent comprehensive review has looked beyond the place of testosterone in the male reproductive system and for the treatment of erectile dysfunction (impotence) to examine the key role of testosterone in the development and treatment of obesity and associated diseases. The article reviewed the evidence for the effects on insulin sensitivity, visceral fat and cholesterol levels of returning low testosterone levels to normal, and addressed the safety of testosterone, particularly in elderly men.

Last updated: 2019
G.MKT.GM.MH.02.2018.0506