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It is well documented that obesity may cause hypogonadism, and that hypogonadism may cause obesity. This has generated debate about what condition comes first; obesity or hypogonadism? And what should be the first point of intervention?
In this editorial we summarize data from several reviews on the association of obesity and hypogonadism, and make the case that obesity and hypogonadism create a self-perpetuating vicious circle. Once a vicious circle has been established, it doesn’t matter where one intervenes; one can either treat the obese condition or treat hypogonadism first. The critical issue is to break the vicious circle as soon as possible before irreversible health damage arises.
Nevertheless, as we will explain here, treating hypogonadism first may prove more effective in that it to a large extent “automatically” takes care of the excess body fat and metabolic derangements, and also confers psychological benefits that will help obese men become more physically active. Thereby, restoring testosterone levels in hypogonadal obese men will relatively quickly break the self-perpetuating vicious circle, and transform it into a “health promoting circle.”
This paper presents the findings from a study that looked at the effects of testosterone on body fat, lean mass, thigh-muscle area and strength, and sexual function in healthy men who had their testosterone levels experimentally reduced. As the majority of estradiol (a form of estrogen) is obtained from testosterone, the concomitant decrease in estradiol was also investigated and the effects differentiated from those of testosterone
In discussions about side effects of testosterone treatment, prostate cancer and heart disease get most attention. However, as we have described in several study reports published here in the “Research News” section, the widespread fear of prostate cancer and heart disease is unfounded and not supported by medical research.
The expected potential side effect of testosterone treatment - which in fact is a therapeutic effect in men with anemia - is an increased level of red blood cells, known as erythrocytosis or polycythemia. In the context of testosterone treatment, erythrocytosis and polycythemia are used interchangeably to refer to an abnormal increase of hemoglobin or hematocrit, which may increase blood thickness.
Elevated hematocrit is the most common side-effect of testosterone treatment. The consequences of a high hematocrit level is unclear, but it may theoretically be associated with an increased risk of blood clots. Here we summarize the results of an analysis of the effect of testosterone treatment on risk of blood clots, published in the Journal of Investigative Medicine.