Shenoy Mohan T, Mondal Sunetra, Fernandez Cornelius James, Pappachan Joseph M
Department of Endocrinology, Sree Gokulam Medical College, and Research Foundation, Trivandrum 695607, Kerala, India.
Department of Endocrinology, NRS Medical College and Hospital, Kolkata 700014, West Bengal, India.
World J Exp Med. 2024 Jun 20;14(2):93689. doi: 10.5493/wjem.v14.i2.93689.
The global obesity pandemic has resulted in a rise in the prevalence of male obesity-related secondary hypogonadism (MOSH) with emerging evidence on the role of testosterone therapy. We aim to provide an updated and practical approach towards its management. We did a comprehensive literature search across MEDLINE ( PubMed), Scopus, and Google Scholar databases using the keywords "MOSH" OR "Obesity-related hypogonadism" OR "Testosterone replacement therapy" OR "Selective estrogen receptor modulator" OR "SERM" OR "Guidelines on male hypogonadism" as well as a manual search of references within the articles. A narrative review based on available evidence, recommendations and their practical implications was done. Although weight loss is the ideal therapeutic strategy for patients with MOSH, achievement of significant weight reduction is usually difficult with lifestyle changes alone in real-world practice. Therefore, androgen administration is often necessary in the management of hypogonadism in patients with MOSH which also improves many other comorbidities related to obesity. However, there is conflicting evidence for the appropriate use of testosterone replacement therapy (TRT), and it can also be associated with complications. This evidence-based review updates the available evidence including the very recently published results of the TRAVERSE trial and provides comprehensive clinical practice pearls for the management of patients with MOSH. Before starting testosterone replacement in functional hypogonadism of obesity, it would be desirable to initiate lifestyle modification to ensure weight reduction. TRT should be coupled with the management of other comorbidities related to obesity in MOSH patients. Balancing the risks and benefits of TRT should be considered in every patient before and during long-term management.
全球肥胖症流行导致男性肥胖相关继发性性腺功能减退（MOSH）的患病率上升，关于睾酮治疗作用的证据也不断涌现。我们旨在提供一种最新且实用的管理方法。我们使用关键词“MOSH”或“肥胖相关性性腺功能减退”或“睾酮替代疗法”或“选择性雌激素受体调节剂”或“SERM”或“男性性腺功能减退指南”，在MEDLINE（PubMed）、Scopus和谷歌学术数据库中进行了全面的文献检索，并对文章中的参考文献进行了人工检索。基于现有证据、建议及其实际意义进行了叙述性综述。虽然体重减轻是MOSH患者的理想治疗策略，但在现实世界的实践中，仅通过生活方式改变实现显著体重减轻通常很困难。因此，在MOSH患者性腺功能减退的管理中，雄激素给药往往是必要的，这也能改善许多与肥胖相关的其他合并症。然而，关于睾酮替代疗法（TRT）的适当使用存在相互矛盾的证据，而且它也可能与并发症相关。这篇基于证据的综述更新了现有证据，包括TRAVERSE试验最近发表的结果，并为MOSH患者的管理提供了全面的临床实践要点。在开始对肥胖功能性性腺功能减退进行睾酮替代治疗之前，最好先进行生活方式调整以确保体重减轻。TRT应与MOSH患者中与肥胖相关的其他合并症的管理相结合。在每位患者的长期管理之前和期间，都应考虑权衡TRT的风险和益处。
