Obesity and Testicular Function

Obesity is a widespread emergency in industrialised countries, and its incidence is expected to increase over the time. The presence of endocrine comorbidities in obese men is often neglected. Many studies have demonstrated that in severely obese patients a state of secondary ‘panhypopituitarism’ may occur, along with multiple endocrine peripheral defects, i.e. hypogonadism, sexual disturbances, vitamin D deficiency, osteoporosis and thyroid and growth hormone secretion disturbances. The recognition and appropriate treatment of these obesity-associated conditions is important to make the patient aware that weight loss and the achievement of the right body composition target is possible. Testosterone replacement therapy (TRT) in obese hypogonadal men is still a matter of debate because it is poorly understood whether obesity precedes or is rather the cause of reduced testicular function. The aim of this chapter will be to describe the pathophysiology of testicular dysfunctions occurring in obese men and the possibility to commence TRT in order to correct hypogonadism along with lifestyle modifications. Evidence-based medicine is growing up, and the most recent studies (controlled and uncontrolled) regarding efficacy and safety of TRT in obese men will be discussed.