Di Vincenzo Angelo, Busetto Luca, Vettor Roberto, Rossato Marco
Department of Medicine-DIMED, Center for the Study and Integrated Management of Obesity, Clinica Medica 3, University-Hospital of Padova, Padova, Italy.
Front Endocrinol (Lausanne). 2018 Dec 18;9:769. doi: 10.3389/fendo.2018.00769. eCollection 2018.
Overweight and obesity are associated with several chronic complications, such as type 2 diabetes, arterial hypertension and atherosclerotic cardiovascular diseases, with relevant consequences for patients and public health systems. Reproductive function abnormalities, such as obesity-related secondary hypogonadism, erectile dysfunction and infertility, represent other abnormalities negatively affecting the quality of life of men suffering from obesity but, despite their high prevalence, these are often understated because of a general lack of awareness in clinical practice. Obesity and gonadal function are closely related, with obesity being associated with hypogonadism that is reversed by body weight reduction thus ameliorating reproductive and sexual health. Clinical studies specifically evaluating the impact of non-surgical weight loss on testosterone levels sometimes showed conflicting results, whereas extensive literature has demonstrated that weight loss after bariatric surgery is correlated with an increase in testosterone levels greater than that obtained with only lifestyle interventions, suggesting the role of surgery also for the treatment of hypogonadism in obese male. However, studies concerning the consequences of bariatric surgery on overall reproductive function in the male, including also sexual activity and fertility, are limited and data regarding long-term effects are lacking. Here we present a brief review summarizing the evidence regarding the interplay between obesity and reproductive abnormalities in the obese male, together with the role of bariatric surgery for the treatment of these complications, describing both the positive effects and the limitations of this procedure.
超重和肥胖与多种慢性并发症相关，如2型糖尿病、动脉高血压和动脉粥样硬化性心血管疾病，给患者和公共卫生系统带来了相应后果。生殖功能异常，如肥胖相关的继发性性腺功能减退、勃起功能障碍和不育，是其他对肥胖男性生活质量产生负面影响的异常情况，但尽管其患病率很高，由于临床实践中普遍缺乏认识，这些情况往往被低估。肥胖与性腺功能密切相关，肥胖与性腺功能减退有关，体重减轻可逆转性腺功能减退，从而改善生殖和性健康。专门评估非手术减肥对睾酮水平影响的临床研究有时显示出相互矛盾的结果，而大量文献表明，减肥手术后体重减轻与睾酮水平升高相关，且升高幅度大于仅通过生活方式干预所获得的幅度，这表明手术在治疗肥胖男性性腺功能减退方面也发挥着作用。然而，关于减肥手术对男性整体生殖功能（包括性活动和生育能力）影响的研究有限，且缺乏关于长期影响的数据。在此，我们简要综述总结了肥胖男性中肥胖与生殖异常之间相互作用的证据，以及减肥手术在治疗这些并发症中的作用，描述了该手术的积极作用和局限性。
