From the Guidelines
Treatment for low testosterone and weight issues, specifically hypogonadism and obesity, should prioritize lifestyle modifications, including weight loss and increased physical activity, alongside testosterone replacement therapy (TRT) for eligible patients, as this approach can improve sexual functioning, quality of life, and potentially reduce cardiovascular risks. When considering TRT, options include injectable testosterone cypionate or enanthate, daily transdermal gels, patches, or pellets implanted subcutaneously 1. For obesity management, a comprehensive approach includes:
- Caloric restriction (500-1000 calories below maintenance)
- Regular exercise (150+ minutes weekly of moderate activity)
- Behavioral therapy
- Possibly medications like GLP-1 agonists (semaglutide, liraglutide) or orlistat These treatments work synergistically as testosterone helps increase muscle mass and reduce fat mass, while weight loss can naturally increase testosterone levels 1. Regular monitoring is essential, including:
- Testosterone levels
- Hematocrit
- PSA for men over 40
- Metabolic parameters Potential side effects of TRT include polycythemia, sleep apnea exacerbation, and possible cardiovascular risks, while weight loss medications have their own side effect profiles that require monitoring 1. It's crucial to note that long-term efficacy and safety of testosterone therapy are unknown, and its use should be carefully considered, especially in older men without well-established medical conditions known to cause hypogonadism 1.
From the FDA Drug Label
Testosterone Enanthate Injection, USP is indicated for replacement therapy in conditions associated with a deficiency or absence of endogenous testosterone. Primary hypogonadism (congenital or acquired) – Testicular failure due to cryptorchidism, bilateral torsion, orchitis, vanishing testis syndrome, or orchidectomy Hypogonadotropic hypogonadism (congenital or acquired) – Gonadotropin or luteinizing hormone‑releasing hormone (LHRH) deficiency, or pituitary-hypothalamic injury from tumors, trauma, or radiation.
The treatment options for low testosterone and weight issues, specifically hypogonadism and obesity, include testosterone replacement therapy with testosterone enanthate injection. However, safety and efficacy of Testosterone Enanthate Injection, USP in men with age-related hypogonadism have not been established 2.
- Key considerations for treatment include:
- Monitoring for potential adverse effects such as hypercalcemia, peliosis hepatis, and hepatic neoplasms
- Evaluating patients for venous thromboembolic events, including deep vein thromosis (DVT) and pulmonary embolism (PE)
- Informing patients of the possible risk of major adverse cardiovascular events (MACE) associated with testosterone replacement therapy 2
- Treatment goals should be individualized and may include improving symptoms of hypogonadism, such as low libido and fatigue, while minimizing potential risks.
From the Research
Treatment Options for Low Testosterone and Weight Issues
- Treatment for hypogonadism, a condition characterized by low testosterone levels, can be achieved through various methods, including testosterone replacement therapy (TRT) 3, 4.
- TRT can be administered through different formulations, such as transdermal testosterone replacement therapy, which is discussed in detail in a 2014 study 4.
- However, TRT may not be suitable for all individuals, particularly those wishing to preserve fertility or with certain medical conditions, and alternative treatments such as gonadotropins, clomiphene citrate, and tamoxifen may be considered 5, 6.
- Lifestyle modifications, including diet and exercise, improvements in sleep, decreasing stress, and varicocele repair, can also increase testosterone levels and may be considered as alternatives to TRT 5.
Relationship Between Testosterone and Obesity
- Low testosterone levels are associated with increased fat mass and reduced lean mass in males, which can lead to metabolic dysfunction 7.
- A bidirectional relationship between testosterone and obesity exists, where low testosterone levels can contribute to obesity, and weight loss can lead to increased testosterone levels 7.
- Testosterone replacement therapy may be an effective adjunctive treatment for weight management in obese men with concomitant hypogonadism, as it can have beneficial effects on measures of obesity and metabolic function 7.
Considerations for Treatment
- The choice of treatment for low testosterone and weight issues should be individualized, taking into account the patient's medical history, fertility desires, and other factors 5, 6.
- A comprehensive treatment plan may involve a combination of medical therapies, lifestyle modifications, and other interventions to address both low testosterone levels and obesity 5, 7.