Strain G W, Zumoff B, Miller L K, Rosner W, Levit C, Kalin M, Hershcopf R J, Rosenfeld R S
Department of Medicine, Beth Israel Medical Center, New York, New York 10003.
J Clin Endocrinol Metab. 1988 May;66(5):1019-23. doi: 10.1210/jcem-66-5-1019.
To study the ability of weight loss to reverse the hyperestrogenemia-induced hypogonadotropic hypogonadism that occurs in obese men, we measured the 24-h mean plasma free and total estradiol (E2), total estrone, FSH, LH, and free and total testosterone concentrations in 11 healthy obese men (100-305% above desirable body weight) and again 5-39 months later after weight loss of 26-129 kg and restabilization at the new weight. Weight loss produced significant increases in mean plasma total testosterone [240 +/- 116 (+/- SD, 8.5 +/- 4.0) to 377 +/- 113 ng/dL (13.0 +/- 4.0 nmol/L); P less than 0.01], free testosterone [9.5 +/- 5.0 (329 +/- 173) to 13.4 +/- 4.3 ng/dL (464 +/- 149 pmol/L); P less than 0.025], and FSH (6.5 +/- 4.7 to 10.9 +/- 8.5 IU/L; P less than 0.025). Plasma LH was lower than levels in normal men before and after weight loss and did not change significantly (10.3 +/- 4.8 and 10.8 +/- 6.8 IU/L, respectively). There was no change in plasma total E2 [54 +/- 26 (196 +/- 94) to 50 +/- 13 pg/mL (180 +/- 50 pmol/L)], free E2 [1.48 +/- 0.7 (5.37 +/- 2.54) to 1.33 +/- 0.42 pg/mL (4.83 +/- 1.45 pmol/L)], or total estrone [75 +/- 38 (280 +/- 140) to 82 +/- 24 (300 +/- 90) pmol/L], and sex hormone-binding globulin rose from 9.2 +/- 3.2 to 12.9 +/- 5.4 nmol/L (P less than 0.005). The increases in plasma free and total testosterone and sex hormone-binding globulin were proportional to the degree of weight loss. Thus, the hypogonadotropic hypogonadism was largely reversed by the weight loss without any decrease in hyperestrogenemia, its presumed cause. We postulate a change in hypothalamic-pituitary function with weight loss, such that GnRH-gonadotropin secretion becomes less sensitive to suppression by a given amount of estrogen.
为研究体重减轻能否逆转肥胖男性中由高雌激素血症引起的促性腺激素分泌不足性性腺功能减退，我们测量了11名健康肥胖男性（体重比理想体重高100% - 305%）24小时平均血浆游离雌二醇和总雌二醇（E2）、总雌酮、促卵泡生成素（FSH）、促黄体生成素（LH）以及游离睾酮和总睾酮浓度，在体重减轻26 - 129 kg并在新体重稳定5 - 39个月后再次测量。体重减轻使血浆平均总睾酮显著升高[从240±116（±标准差，8.5±4.0）ng/dL升至377±113 ng/dL（13.0±4.0 nmol/L）；P＜0.01]，游离睾酮[从9.5±5.0（329±173）ng/dL升至13.4±4.3 ng/dL（464±149 pmol/L）；P＜0.025]，以及FSH（从6.5±4.7升至10.9±8.5 IU/L；P＜0.025）。血浆LH在体重减轻前后均低于正常男性水平且无显著变化（分别为10.3±4.8和10.8±6.8 IU/L）。血浆总E2[从54±26（196±94）pg/mL降至50±13 pg/mL（180±50 pmol/L）]、游离E2[从1.48±0.7（5.37±2.54）pg/mL降至1.33±0.42 pg/mL（4.83±1.45 pmol/L）]或总雌酮[从75±38（280±140）pmol/L降至82±24（300±90）pmol/L]均无变化，且性激素结合球蛋白从9.2±3.2升至12.9±5.4 nmol/L（P＜0.005）。血浆游离睾酮、总睾酮和性激素结合球蛋白的升高与体重减轻程度成正比。因此，促性腺激素分泌不足性性腺功能减退在很大程度上因体重减轻而得到逆转，而其假定病因高雌激素血症并未降低。我们推测体重减轻会引起下丘脑 - 垂体功能变化，使得促性腺激素释放激素 - 促性腺激素分泌对一定量雌激素的抑制作用变得不那么敏感。
