Obesity and Testicular Function.

Obesity and Testicular Function.

Mah PM, Wittert GA.

School of Medicine, University of Adelaide, Australia.

Obesity in men, particularly when central, is associated with lower total testosterone [TT], free testosterone [FT] and sex-hormone-binding globulin [SHBG], and a greater decline in TT an FT with increasing age compared with lean men. Obesity-related conditions such as obstructive sleep apnoea, insulin resistance and type 2 diabetes mellitus are independently associated with decreased plasma testosterone. Possible mechanisms include decreased LH pulse amplitude, inhibitory effects of oestrogen at the hypothalamus and pituitary and the effects of leptin and other peptides centrally and on Leydig cells. Obese men have reduced sperm concentration and total sperm count compared to lean men but sperm motility and morphology appear unaffected. The cause and effect relationships between low plasma androgen levels, obesity and the metabolic syndrome, and associated cardiometabolic risk remain unclear. While weight loss normalizes TT and FT in obese men, androgen replacement in the short term does not significantly improve cardiometabolic risk profile despite reducing fat mass.