Santamaria Alvaro, Amighi Arash, Thomas Melbin, Goradia Rajvi, Choy Jeremy, Hehemann Marah C
Department of Urology, University of Washington, Seattle, WA, USA.
Department of Internal Medicine, Division of Metabolism, Endocrinology and Nutrition, University of Washington, Seattle, WA, USA.
Ther Adv Urol. 2024 Sep 13;16:17562872241279648. doi: 10.1177/17562872241279648. eCollection 2024 Jan-Dec.
This review explores the mechanisms and ramifications of weight loss achieved through lifestyle modifications, medical treatments, and bariatric surgery on testosterone levels and sexual health. Obesity significantly affects the hypothalamic-pituitary-gonadal axis in men, leading to diminished libido and erectile dysfunction. Here, we delve into the physiological disruptions caused by this imbalance and the intricate interplay of hormonal factors contributing to the dysregulation associated with obesity to comprehensively grasp the consequences of weight loss via diverse mechanisms. Lifestyle modifications involving dietary adjustments and regular exercise represent a widely employed and efficacious means of weight loss. While adherence demands discipline, our review scrutinizes various studies specifically investigating the impact of weight loss, attained through lifestyle modifications, on serum hormone levels and sexual function. Notably, several randomized controlled trials within the existing body of literature corroborate the enhancement of testosterone levels and sexual function consequent to weight loss through lifestyle modifications. The realm of medical management in addressing obesity is growing, notably propelled by the popularity of pharmacotherapy. Despite its prevalence, the current literature exploring the effects of weight loss medications on men remains insufficient. Nonetheless, we examine available studies on the medical management of obesity and its implications for sexual health, emphasizing pivotal avenues requiring further investigation. Bariatric surgery stands as an effective approach for individuals seeking substantial weight loss. Our review assesses existing literature that evaluates the impact of various surgical techniques on serum hormone levels, sexual function, and semen parameters. Despite certain limitations, the available body of evidence suggests enhancements in hormone levels and sexual function post-surgery, with semen parameters generally exhibiting minimal changes. This review critically evaluates the landscape of weight loss and its correlation with sexual function, while highlighting crucial areas necessitating future research endeavors.
本综述探讨了通过生活方式改变、医学治疗和减肥手术实现体重减轻对睾酮水平和性健康的机制及影响。肥胖对男性下丘脑 - 垂体 - 性腺轴有显著影响，导致性欲减退和勃起功能障碍。在此，我们深入研究这种失衡所引起的生理紊乱以及导致与肥胖相关失调的激素因素之间的复杂相互作用，以全面了解通过多种机制减肥的后果。涉及饮食调整和定期锻炼的生活方式改变是一种广泛采用且有效的减肥方法。虽然坚持需要自律，但我们的综述仔细审查了各项专门研究通过生活方式改变实现体重减轻对血清激素水平和性功能影响的研究。值得注意的是，现有文献中的几项随机对照试验证实，通过生活方式改变减肥后，睾酮水平和性功能会得到改善。治疗肥胖的医学管理领域正在不断发展，尤其是药物治疗的普及推动了这一发展。尽管药物治疗很普遍，但目前探索减肥药物对男性影响的文献仍然不足。尽管如此，我们研究了关于肥胖医学管理及其对性健康影响的现有研究，强调了需要进一步研究的关键领域。减肥手术是寻求大幅减重的个人的有效方法。我们的综述评估了现有文献，这些文献评估了各种手术技术对血清激素水平、性功能和精液参数的影响。尽管存在某些局限性，但现有证据表明手术后激素水平和性功能有所改善，精液参数一般变化不大。本综述批判性地评估了减肥领域及其与性功能的相关性，同时突出了需要未来研究努力的关键领域。
