Testosterone Therapy for Prevention and Treatment of Obesity in Men

Testosterone deficiency (TD) is common in men with obesity. The association between TD and obesity is bidirectional; low testosterone (T) is a contributing cause to obesity, and obesity is a contributing cause to low T, creating a vicious circle. Most guidelines recommend weight loss by diet/exercise as the first point of intervention to stop this vicious cycle. However, it requires a large amount of weight loss that is maintained over time. In clinical practice, this is rarely achieved by lifestyle interventions. Bariatric surgery is currently the main obesity treatment modality that results in a large amount of weight loss with decent weight loss maintenance. However, bariatric surgery is an invasive and expensive procedure, with risk for complications. Considering the high prevalence of TD in men with obesity, a more practical and sustainable obesity treatment for men is testosterone therapy (TTh). Thanks to the metabolic effects of T, TTh results in more fat loss and preservation of fat-free mass, compared with diet/exercise interventions alone. In contrast to weight loss achieved by diet/exercise and bariatric surgery, TTh significantly preserves both muscle and bone mass. Further, TTh has psychological effects that may increase the motivation and ability of men to adhere to diet/exercise programs. Real-world evidence studies of long-Term TTh for up to 11 years provide compelling evidence that TTh holds tremendous potential as a new treatment modality for obesity in men, with long-Term weight loss maintenance and health benefits far exceeding those achieved by lifestyle interventions, approved obesity drugs, as well as bariatric surgery.