In a prior blog "Male Andropause vs. Oxidative Stress Hypogonadism", I discussed the typical age of men who are in andropause and younger men who are suffering from hypogonadism related to oxidative stress. In review of these two syndromes, both have similiar signs, symptoms, and a subtle onset. The end result in both syndromes is obesity.
In this blog I want to discuss the hormonal effects in male obesity. Obesity is largely due to stress, a poor diet, and lack of exercise. A poor lifestyle leads to oxidative changes within the body which causes insulin to rise in response to a poor dietary regimen. When insulin rises approximately midway there is unwanted weight gain usually in the abdomen first, then all over. Men, who have a family history of diabetes are at a higher risk of developing adult onset diabetes quicker than men who do not have a family history of diabetes. As a result, the insulin level rises as the body's tissues become resistant causing blood sugars to rise above a normal range. Usually, the postpriandial blood sugar rises before the fasting blood sugar. Other metabolic changes include an elevated LDL , triglycerides, and lowered HDL. Hypertension and hypothyroidism are other metabolic diseases that are manifested from oxidative changes within the body.
Testosterone is produced in the testes from FSH secreted from the pituitary gland. In obese males with insulin resistance a hormone disturbance is created with lowered testosterone levels and elevated estradiol levels. The hormonal changes cause decreased metabolism, rising blood sugars, mood instability, lethargy, altered lipid levels,erectile dysfunction, infertility and decreased libido. The physical and emotional symptoms are similar to the women's menopausal symptoms. A cycle of unwanted weight gain with carbohydrate craving further complicate obesity and hypogonadism.
In young men who want to have children, the treatment is focused on a structured medical weight loss program. The insulin resistance is treated with a low glycemic diet and metformin. Also they are encouraged to start weight training which will enhance their natural testosterone and weight loss. Success in reversing the hormone imbalance depends on the patient's attitude to lose the weight. After six months of a structured weight loss program and no progress then HCG is offered at 500IU per day to start and titrated accordingly to the testosterone level. Once HCG is started it is not stopped or the testosterone level will drop and the estradiol level will rise contributing to weight gain and other previously mentioned symptoms. HCG stimulates the testes to make more testosterone which helps to lower the estradiol level.
In older middle aged men, the difference in treatment is they can be started on compounded testerone cream, if they do not want more children. Also, they are started on a weight loss program with metformin and if there is presence of cardiac risk factors a stress test is done before exercise is prescribed. In the healthy older men a weighted exercise program is prescribed with a low glycemic diet to follow. The testosterone cream is weight based and titrated according to testosterone levels. If any other metabolic disturbances are diagnosed they are treated according to the standard of care such as hypertension, hypothyroidism, and dyslipidemia with appropriate medications.
All men on the medical weight loss program are seen every two weeks for evaluation. Other supplements include Vita-Cell B injections, B50 Complete, and Lap Band in a Bottle. The supplements, medications along with dietary restrictions and weighted exercise will enhance weight loss which corrects the hormonal disturbance.