If extremely obese men lose weight after having a stomach reduction, their testosterone levels rise to levels found in healthy, slim men. But the erection problems that many obese men suffer from don’t disappear, write Brazilian doctors working at the Hospital das Clinicas in Sao Paulo in Surgery for Obesity and Related Diseases.
Fat mass & testosterone
Fat men have less testosterone in their blood than slim men. Too much body fat disturbs the body’s hormone balance and reduces testosterone production. Some studies have shown that overweight can reduce the concentration of testosterone by as much as a half.
Declining testosterone levels as men age are not entirely due to the process of aging. It’s also a consequence of the growing belly they develop and the decline in health that accompanies this. [Urology. 2003 Mar;61(3): 629-33.] It’s not surprising that obese men often have erection problems. [JAMA. 2004 Jun 23;291(24): 2978-84.]
The solution is simple. If overweight men lose weight their testosterone levels rise and their erections improve.
But for some men losing weight is too difficult, so they resort to an operation. This is what the 23 men that the Brazilians studied had done. Now aged between 30 and 65, they had all had a Roux-en-Y gastric bypass six to fourteen years previously. The clip below, made by the Mayo Clinic, explains what this entails.
Surgeons perform their tricks on the stomach and small intestine, so food only passes through a small part of the stomach, going directly to the small intestine. The rest of the stomach is kept in place, and continues to produce enzymes and juices, which make their way to the small intestine where they help with the process of digestion.
The researchers compared the men who had been operated on with a dozen healthy, slim men, and a dozen obese men who had not undergone an operation. The results are shown in the table below.
“The normalization of some, but not all, preoperative clinical aberrations could underlie the dichotomy between the obviously elevated testosterone levels and the incompletely restored sexual drive and performance”, the Brazilians write. “General health benefitted from gastric bypass, as demonstrated by the robust weight loss and a healthier metabolic profile than comparable nonoperated obese participants.”
“All these advantages notwithstanding, many participants were still affected by residual obesity, sleep apnea, arterial hypertension, and assorted aberrations of glucose and lipid homeostasis, which could interfere with erectile function.”
Sexual hormones and erectile function more than 6 years after bariatric surgery.
The long-term effect of bariatric intervention on androgenic hormones and erectile function is not well known. In a prospective comparative study, the profile of sexual function was ascertained. The setting was a large public academic hospital.
A total of 51 patients were included in the present study. Of these, 23 were in the bariatric surgery cohort (with 6-14 yr of follow-up), 14 were obese controls, and 14 were lean controls, aged 30-65 years. The groups were matched for age and, in the case of obese controls, the current body mass index. The measurements included orchidometry, an assessment of gynecomastia, the International Index of Erectile Function, the Aging Males Symptoms questionnaire, the measurement of 12 hormones, and general biochemical measurements.
Bariatric patients lost substantial weight (59.8 ± 12.1 versus 35.1 ± 7.7 kg/m(2)), albeit residual obesity was the rule, with varying degrees of sleep apnea, hypertension, and glucose/lipid aberrations. The total and free testosterone and sex hormone-binding globulin levels were greater in the gastric bypass patients than in the obese controls and comparable to those of lean individuals. The International Index of Erectile Function final score revealed no differences; however, the domains of erectile dysfunction (P = .015) and overall satisfaction (P = .028) were better than those in the obese controls, although still lower than those in the lean group. The correlation between the body mass index and the International Index of Erectile Function score in the entire population (n = 51) was negative, as expected, with, however, low r and r(2) indexes (.354 and .125, respectively).
The findings are consistent with long-term normalization of androgenic hormones but less than complete normalization of erectile function. This seeming contradiction might be explained by the remaining or relapsing obesity or its co-morbidities.
PMID: 22901968 [PubMed – indexed for MEDLINE]