Shenoy MT, Mondal S, Fernandez CJ, Pappachan JM. Management of male obesity-related secondary hypogonadism: A clinical update. World J Exp Med 2024; 14(2): 93689 [DOI: 10.5493/wjem.v14.i2.93689]
Corresponding Author of This Article
Joseph M Pappachan, MD, FRCP, Academic Editor, Consultant, Professor, Department of Endocrinology and Metabolism, Lancashire Teaching Hospitals NHS Trust, Sharoe Green Lane, Preston PR2 9HT, United Kingdom. drpappachan@yahoo.co.in
Research Domain of This Article
Endocrinology & Metabolism
Article-Type of This Article
Review
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Exp Med. Jun 20, 2024; 14(2): 93689 Published online Jun 20, 2024. doi: 10.5493/wjem.v14.i2.93689
Management of male obesity-related secondary hypogonadism: A clinical update
Mohan T Shenoy, Sunetra Mondal, Cornelius James Fernandez, Joseph M Pappachan
Mohan T Shenoy, Department of Endocrinology, Sree Gokulam Medical College, and Research Foundation, Trivandrum 695607, Kerala, India
Sunetra Mondal, Department of Endocrinology, NRS Medical College and Hospital, Kolkata 700014, West Bengal, India
Cornelius James Fernandez, Department of Endocrinology & Metabolism, Pilgrim Hospital, United Lincolnshire Hospitals NHS Trust, Boston PE21 9QS, United Kingdom
Joseph M Pappachan, Department of Endocrinology and Metabolism, Lancashire Teaching Hospitals NHS Trust, Preston PR2 9HT, United Kingdom
Joseph M Pappachan, Faculty of Science, Manchester Metropolitan University, Manchester M15 6BH, United Kingdom
Joseph M Pappachan, Faculty of Biology, Medicine & Health, The University of Manchester, Manchester M13 9PL, United Kingdom
Co-first authors: Mohan T Shenoy and Sunetra Mondal.
Author contributions: Shenoy MT and Mondal S contributed to the initial drafting of the work by performing the literature search, interpretation of relevant literature, and share the first authorship; Fernandez CJ prepared the figures for the manuscript and contributed additionally to the drafting process; Pappachan JM conceptualized the idea and provided overall supervision to the drafting process; all authors contributed to the revision of the article for important intellectual content, and have read and approved the final version of the manuscript.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Joseph M Pappachan, MD, FRCP, Academic Editor, Consultant, Professor, Department of Endocrinology and Metabolism, Lancashire Teaching Hospitals NHS Trust, Sharoe Green Lane, Preston PR2 9HT, United Kingdom. drpappachan@yahoo.co.in
Received: March 3, 2024 Revised: April 22, 2024 Accepted: May 15, 2024 Published online: June 20, 2024 Processing time: 107 Days and 12.4 Hours
Abstract
The global obesity pandemic has resulted in a rise in the prevalence of male obesity-related secondary hypogonadism (MOSH) with emerging evidence on the role of testosterone therapy. We aim to provide an updated and practical approach towards its management. We did a comprehensive literature search across MEDLINE (via PubMed), Scopus, and Google Scholar databases using the keywords “MOSH” OR “Obesity-related hypogonadism” OR “Testosterone replacement therapy” OR “Selective estrogen receptor modulator” OR “SERM” OR “Guidelines on male hypogonadism” as well as a manual search of references within the articles. A narrative review based on available evidence, recommendations and their practical implications was done. Although weight loss is the ideal therapeutic strategy for patients with MOSH, achievement of significant weight reduction is usually difficult with lifestyle changes alone in real-world practice. Therefore, androgen administration is often necessary in the management of hypogonadism in patients with MOSH which also improves many other comorbidities related to obesity. However, there is conflicting evidence for the appropriate use of testosterone replacement therapy (TRT), and it can also be associated with complications. This evidence-based review updates the available evidence including the very recently published results of the TRAVERSE trial and provides comprehensive clinical practice pearls for the management of patients with MOSH. Before starting testosterone replacement in functional hypogonadism of obesity, it would be desirable to initiate lifestyle modification to ensure weight reduction. TRT should be coupled with the management of other comorbidities related to obesity in MOSH patients. Balancing the risks and benefits of TRT should be considered in every patient before and during long-term management.
Core Tip: The obesity pandemic has increased the prevalence of obesity-related health morbidities including male obesity-related secondary hypogonadism (MOSH). Although weight loss is the ideal therapeutic option for MOSH, testosterone replacement therapy (TRT) is often necessary because of the difficulty in achieving significant weight loss through lifestyle interventions or pharmacotherapy which might also improve obesity-related comorbidities. TRT should be coupled with the management of other comorbidities related to obesity in MOSH patients to optimize management which is updated in this evidence-based review.
