From the Guidelines
No, overweight people with low testosterone do not have access to the same amount of testosterone as those with normal weight. Excess body fat, particularly abdominal fat, increases the activity of an enzyme called aromatase, which converts testosterone to estrogen, as noted in studies such as 1. This conversion reduces the amount of bioavailable testosterone in the body. Additionally, obesity is associated with higher levels of sex hormone-binding globulin (SHBG), which binds to testosterone and makes it unavailable for use by the body's tissues. Some key points to consider include:
- Weight loss through diet and exercise can help improve testosterone levels naturally.
- For those diagnosed with clinically low testosterone, treatment options include testosterone replacement therapy (TRT) in various forms such as injections, daily transdermal gels, patches, or pellets implanted under the skin.
- The dosing may need to be adjusted for overweight individuals, and weight loss is often recommended alongside TRT for optimal results, as discussed in 1.
- The relationship between obesity and testosterone is bidirectional - low testosterone promotes fat accumulation, while excess fat reduces testosterone, creating a challenging cycle that often requires both weight management and hormone treatment to address effectively. It's also important to consider the potential risks and benefits of testosterone replacement therapy, as well as the need for ongoing monitoring and evaluation to ensure optimal treatment outcomes.
From the Research
Access to Testosterone for Overweight People with Low Testosterone
- Overweight people with low testosterone may have limited access to the same amount of testosterone due to various factors, including obesity-related reductions in testosterone production 2.
- Weight loss, particularly through reductions in body mass index (BMI), has been shown to have 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 also been linked to increased testosterone production in men with obesity 2.
- Testosterone replacement therapy (TRT) is an option for men with low testosterone, but it may not be suitable for all individuals, particularly those who desire to preserve fertility 3, 4, 5.
- Alternative approaches, such as selective estrogen receptor modulators, gonadotropins, and aromatase inhibitors, may be used to increase endogenous testosterone production while preserving fertility, but these methods are still in the early stages of development 3, 5.
Treatment Options for Low Testosterone
- TRT is available in various formulations, including oral, buccal, intramuscular, transdermal, subdermal, and nasal preparations, and can restore normal serum testosterone concentrations and relieve symptoms in most hypogonadal men 4, 6.
- The selection of TRT method depends on the patient's preference and physician's advice, and dose adjustment is possible with most delivery methods 4.
- Clomiphene citrate and human chorionic gonadotropin are alternative treatments that can increase endogenous testosterone production, but their efficacy as treatments for hypogonadal symptoms is still under debate 5.