Sarwer David B, Spitzer Jacqueline C, Wadden Thomas A, Rosen Raymond C, Mitchell James E, Lancaster Kathy, Courcoulas Anita, Gourash William, Christian Nicholas J
Department of Psychiatry, Center for Weight and Eating Disorders, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Department of Surgery, Division of Plastic Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
Department of Psychiatry, Center for Weight and Eating Disorders, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
Surg Obes Relat Dis. 2015 May-Jun;11(3):643-51. doi: 10.1016/j.soard.2014.12.014. Epub 2014 Dec 23.
The relationship between obesity and impairments in male sexual functioning is well documented. Relatively few studies have investigated changes in sexual functioning and sex hormones in men who achieve significant weight loss with bariatric surgery. The objective of this study was to assess changes in sexual functioning, sex hormones, and relevant psychosocial constructs in men who underwent bariatric surgery.
A prospective cohort study of 32 men from the Longitudinal Assessment of Bariatric Surgery-2 (LABS) investigation who underwent a Roux-en-Y gastric bypass (median body mass index [25th percentile, 75th percentile] 45.1 [42.0, 52.2]) and completed assessments between 2006 and 2012. Bariatric surgery was performed by a LABS-certified surgeon. Sexual functioning was assessed by the International Index of Erectile Functioning (IIEF). Hormones were assessed by blood assay. Quality of life (QoL), body image, depressive symptoms and marital adjustment were assessed by questionnaire.
Men lost, on average, (95% confidence interval) 33.3% (36.1%, 30.5%) of initial weight at postoperative year 1, 33.6% (36.8%, 30.5%) at year 2, 31.0% (34.1%, 27.9%) at year 3, and 29.4% (32.7%, 26.2%) at year 4. Participants experienced significant increases in total testosterone (P<.001) and sex hormone binding globulin (SHBG) (P<.001) through postoperative year 4. Although men reported improvements in sexual functioning after surgery, these changes did not significantly differ from baseline, with the exception of overall satisfaction at postoperative year 3 (P = .008). Participants reported significant improvements in physical domains of health-related quality of life (HRQoL), all domains of weight-related QOL, and body image, but not in the mental health domains of HRQoL or relationship satisfaction.
Men who lost approximately one third of their weight after Roux-en-Y gastric bypass experienced significant increases in total testosterone and SHBG. They did not, however, report significant improvements in sexual functioning, relationship satisfaction, or mental health domains of HRQoL. This pattern of results differs from that of women who have undergone bariatric surgery, who reported almost uniform improvements in sexual functioning and psychosocial status.
肥胖与男性性功能障碍之间的关系已有充分记录。相对较少的研究调查了通过减肥手术实现显著体重减轻的男性性功能和性激素的变化。本研究的目的是评估接受减肥手术的男性在性功能、性激素和相关心理社会指标方面的变化。
一项前瞻性队列研究，对来自减肥手术纵向评估-2（LABS-2）调查的32名男性进行研究，这些男性接受了Roux-en-Y胃旁路手术（中位体重指数[第25百分位数，第75百分位数]为45.1[42.0，52.2]），并在2006年至2012年期间完成了评估。减肥手术由LABS认证的外科医生进行。性功能通过国际勃起功能指数（IIEF）进行评估。激素通过血液检测进行评估。生活质量（QoL）、身体形象、抑郁症状和婚姻调适通过问卷调查进行评估。
男性在术后第1年平均减轻了（95%置信区间）初始体重的33.3%（36.1%，30.5%），第2年为33.6%（36.8%，30.5%），第3年为31.0%（34.1%，27.9%），第4年为29.4%（32.7%，26.2%）。参与者在术后第4年总睾酮（P<.001）和性激素结合球蛋白（SHBG）（P<.001）显著增加。尽管男性报告术后性功能有所改善，但这些变化与基线相比无显著差异，术后第3年的总体满意度除外（P = .008）。参与者报告在健康相关生活质量（HRQoL）的身体领域、与体重相关的QoL的所有领域以及身体形象方面有显著改善，但在HRQoL的心理健康领域或关系满意度方面没有改善。
接受Roux-en-Y胃旁路手术后体重减轻约三分之一的男性，其总睾酮和SHBG显著增加。然而，他们在性功能、关系满意度或HRQoL的心理健康领域并未报告有显著改善。这种结果模式与接受减肥手术的女性不同，女性报告在性功能和心理社会状况方面几乎都有改善。
