Does class III obesity (severe or morbid obesity) affect testosterone levels and libido?

From the Guidelines

Morbid obesity has a significant impact on testosterone levels and libido, primarily due to the increased conversion of testosterone to estrogen in adipose tissue, leading to lower testosterone levels and potential hypogonadism. This condition can cause a range of symptoms, including reduced sexual desire, erectile dysfunction, fatigue, and mood changes in men, as well as decreased libido and menstrual irregularities in women 1. The relationship between obesity and testosterone is complex, with excess body fat, particularly abdominal fat, increasing the activity of the enzyme aromatase, which converts testosterone to estrogen, thus lowering testosterone levels.

Key Factors to Consider

• Excess body fat, especially abdominal fat, contributes to lower testosterone levels by increasing aromatase activity, which converts testosterone to estrogen.
• Hypogonadism, characterized by low testosterone levels, can result from obesity, leading to symptoms such as reduced libido, erectile dysfunction, and fatigue.
• The measurement of morning serum free testosterone is essential when evaluating low total testosterone in men with obesity, as some may have normal free testosterone levels despite low total testosterone due to low sex hormone-binding globulin concentrations 1.
• Testosterone replacement therapy (TRT) may be considered for individuals with confirmed low testosterone levels, with the goal of alleviating symptoms and improving quality of life.

Treatment and Management

• Weight loss through diet, exercise, and, in some cases, bariatric surgery can help restore normal hormone levels and improve symptoms associated with low testosterone.
• TRT is available in various forms, including injections, gels, patches, and pellets, each with its own advantages and disadvantages, and the choice of therapy should be individualized based on patient preferences and needs 1.
• Regular monitoring of hormone levels, hematocrit, PSA (in men), and other parameters is crucial for patients undergoing TRT to ensure safe and effective treatment.

Conclusion is not needed, the above information is enough to make a decision

Based on the evidence, it is clear that addressing morbid obesity through weight loss and, when necessary, testosterone replacement therapy can significantly improve testosterone levels and libido, ultimately enhancing quality of life. Healthcare providers should consider the complex interplay between obesity, testosterone, and overall health when managing patients with morbid obesity and potential hypogonadism 1.

From the Research

Effect of Morbid Obesity on Testosterone Levels and Libido

• Morbid obesity is linked to reduced testosterone levels, which can lead to metabolic dysfunctions, reduced libido, and diminished muscle mass 2.
• Weight loss, particularly through fat reduction, has a positive influence on testosterone levels, with both moderate and significant reductions in BMI associated with notable increases in serum testosterone levels 2.
• Dietary interventions, such as low-carbohydrate and Mediterranean diets, and exercise, particularly resistance training, have been shown to improve hormonal profiles by lowering fat mass and boosting testosterone levels 2.
• Bariatric surgery has been identified as one of the most effective methods for increasing testosterone in morbidly obese individuals, with improvements sustained over time 2.

Relationship Between Testosterone Levels and Libido

• Low testosterone levels are associated with reduced libido, and normalizing testosterone levels in men with morbid obesity can improve libido and overall health outcomes 3, 4.
• The relationship between obesity, metabolic syndrome, and erectile dysfunction is complex, but it is known that BMI is inversely proportional to serum total testosterone concentrations, and low serum testosterone concentrations are characteristic of obese men with metabolic syndrome and type 2 diabetes mellitus 4.

Management of Morbid Obesity-Related Hypogonadism

• Weight loss is the ideal therapeutic strategy for patients with morbid obesity-related hypogonadism, but achievement of significant weight reduction is usually difficult with lifestyle changes alone 5.
• Testosterone replacement therapy may be necessary in the management of hypogonadism in patients with morbid obesity, but it can also be associated with complications, and balancing the risks and benefits of testosterone replacement therapy should be considered in every patient 5, 6.
• Adding testosterone replacement therapy to intensive lifestyle intervention in older men with obesity and hypogonadism may attenuate the weight loss-induced reduction in muscle mass and hip bone mineral density, and may further improve aerobic capacity 6.