Effects of long-term testosterone treatment in obese hypogonadal men with and without type 2 diabetes.


In this first presentation Professor Saad highlights the epidemic prevalence of obesity and the well-documented finding that hypogonadism is more strongly associated with obesity than with age per se. This is supported by longitudinal studies showing that weight gain and weight loss result in predictable reductions and increases in testosterone levels, respectively, regardless of age. Thus, the term “late-onset hypogonadism” is a misnomer.

Dr. Saad underscores the importance of abdominal obesity; among men presenting with symptomatic hypogonadism only 4% had a waist circumference <94 cm. it is notable that waist circumference is a component of all current definitions of the metabolic syndrome, and that a waist circumference ≥94 cm is a threshold for diagnosis of the metabolic syndrome, according to the harmonized definition.

Several studies, both RCT and observational, support that testosterone replacement therapy results in significant reductions in waist circumference that are clinically meaningful. Notably, the weight and waist loss seen with testosterone replacement therapy is progressive and continuous, as opposed to the typical U-shaped curve seen with traditional obesity treatments. Dr. Saad further presents individual data and highlights that testosterone replacement therapy in obese men unequivocally results in long-term weight loss in all patients, and that the longer patients are treated with testosterone, the greater the achieved weight loss.

Other beneficial effects of testosterone replacement therapy are increases in lean body mass as well as vitality/vigor, both of which may increase energy expenditure; the former, resting energy expenditure, the latter, activity energy expenditure. The gain in lean body mass (muscle) also correlates with reductions in HbA1c, indicating that it drives the improvement in glucose metabolism.

Dr. Saad ends his presentation showing RCT data showing pronounced reductions in HbA1c after long-term 82 week testosterone treatment in poorly controlled type 2 diabetic men. Most amazing is the observation from a registry study showing a progressive and continuous reduction in HbA1c over 7 years.




Prof. H.C. Dr. Farid Saad

Prof.h.c. Dr. Farid Saad,
Global Medical Affairs Andrology, Bayer Pharma AG, Berlin, Germany,
Guld Medical University, Research Department, Ajman, United Arab Emirates,
and Hang tuah University, Men's Health Reproduction Study Center, Surabaya,Indonesia