Treatment with testosterone injections lowers weight and improves metabolic parameters among obese adult male patients with hypogonadism, according to new research presented at the 2020 European and International Congress on Obesity.
"Long-term testosterone therapy in hypogonadal men resulted in profound and sustained in weight loss which may have contributed to reductions in mortality and cardiovascular events. Untreated men with hypogonadism gained weight,” Farid Saad, MD, from the Gulf Medical University School of Medicine, Ajman, UAE, wrote in a press release from The European Association for the Study of Obesity.
Saad and colleagues presented 11 years of data from multiple pieces of research on the effects of testosterone at other congresses, including previous years of the European Congress on Obesity. The latest data show evidence of long-term benefits of testosterone therapy and suggest it could be an effective alternative to bariatric surgery.
Data was collected from a German registry of men in 2004 from a urological practice based in Bremerhaven. The men all had functional hypogonadism, and 471 of 773 men (61%) had obesity. A total of 276 men received testosterone therapy with testosterone undecanoate (TU) for up to 11 years (T-group) and the other 195 men opted against testosterone therapy and served as controls. According to the release, there was 100% adherence to testosterone therapy and no patients dropped from the study.
Researchers compared changes between groups over time and adjusted for age, weight, waist circumference, fasting glucose, blood pressure, blood fats and quality of life to account for baseline differences between the two groups. The mean follow-up period was 8.8 years for the T-group and 8.4 years for controls, and the average age 60.6 years in the T-group and 63.5 years in the control group.
After 11 years of data collection in the registry, the researchers noticed a weight decrease of a mean of 23kg in the T-group (from 114 kg to 89 kg before adjustment, and to 87 kg after adjustment for baseline age, waist circumference, weight, fasting glucose, systolic and diastolic blood pressure, total cholesterol, HDL, LDL, triglycerides and the quality of life scale AMS), while mean weight increased by 6 kg in the control group. The results were similar in terms of percentage with the T-group losing an average of 20% bodyweight, whereas controls increased by 6%.
Patients who received testosterone therapy experienced a waist circumference decrease by a mean 13 cm, while those in the control group saw an increase of 7 cm. There was a BMI index reduction of 7.6 points among patients in the T-group and patients in the control group experienced a BMI increase of 2 points. Measurements of visceral fat were also lower in the T-group, according to the release.
The researchers also observed a significant mortality difference between groups. A total of 21 patients (7.6%) died in the T-group compared with 63 (32.3%) patients in the control group. More than a quarter of men (28%) in the control group experienced a heart attack, and 53 (27.2%) had a stroke. There were no major CV events in the T-group and all mortalities in the T-group were related to traffic and sport accidents and post-surgical infections.
A total of 56.6% of patients in the T-group and 63.6% in the control group had type 2 diabetes at baseline. A further 22.1% of patients developed T2D during the study, totaling 85% of control patients who had T2D after 11 years of follow-up.
There were further studies presented at the ECOICO 2020 congress which studied men in the registry with obesity class III, the highest obesity category making them most eligible for bariatric surgery. A total of 76 of the 773 men (9.8%) fit the criteria and 59 of these men received testosterone therapy as defined above, while the other 17 men opted against this and served as controls.
Researchers saw results that were similar to the whole registry. The findings showed that weight decreased by a mean 30 kg in the T-group and increased by 5 kg in controls. They also saw a BMI decrease of 10 points in the T-group and a 3-point increase in the control group.
“Side effects and complications may be in favor of testosterone therapy,” Saad said. “We believe testosterone therapy should be discussed with patients as an alternative to surgery and should be considered for male patients who cannot undergo surgery."
