Increased adipose tissue in men can have significant clinical repercussions on testosterone levels, leading to a condition known as hypogonadism. This condition is characterized by low testosterone levels and can manifest with various clinical symptoms and complications.
Clinical repercussions
- Hypogonadism: Increased adipose tissue can lead to hypogonadism, a condition characterized by low testosterone levels. This can result in symptoms such as low libido, unexplained chronic fatigue, loss of body hair, and hot flushes
- Metabolic implications: Increased adipose tissue can lead to metabolic dysfunction and insulin resistance, which can further exacerbate the effects of low testosterone levels
- Osteoporosis: Hypogonadism can lead to osteoporosis in men, a condition characterized by decreased bone density and increased risk of fractures. Testosterone therapy is recommended to prevent bone loss and help acquire peak bone mass in young adult patients with hypogonadism
- Adipose tissue fatty acid storage: Acute testosterone deficiency can result in greater femoral adipose tissue meal fatty acid storage rates, fasting and fed lipoprotein lipase activity, and acyl coenzyme A synthetase activity
Diagnostic investigations
- Total testosterone measurement: Guidelines recommend obtaining a measurement of total testosterone in the morning (between 7 and 11 AM) and in the fasting state with a reliable laboratory assay for the evaluation of late-onset hypogonadism
- Free testosterone measurement: In patients with conditions altering sex hormone-binding globulin and when total testosterone concentrations are in the borderline range (~8-12 nmol/L), it is recommended to measure or calculate free testosterone in addition to total testosterone
- Sex hormone-binding globulin measurement: It is recommended to consider obtaining sex hormone-binding globulin and free testosterone calculation when indicated
Treatment considerations
- Testosterone therapy: Testosterone therapy is recommended in patients with hypogonadism to prevent bone loss and help acquire peak bone mass. It is also recommended in patients with obesity and hypogonadism to aid in weight loss, decreased waist circumference, and improvements in metabolic parameters
- Discontinuation of testosterone therapy: If clinical features are not improving despite biochemical restoration for 6-12 months, consider discontinuing testosterone treatment
In conclusion, increased adipose tissue in men can lead to hypogonadism, metabolic dysfunction, and osteoporosis, among other clinical repercussions. Diagnostic investigations and treatment considerations are crucial in managing these conditions.