Normal aging in men leads to decreases in total and bioavailable testosterone concentrations and culminates in a naturally occurring condition known as andropause. However, in approximately 25% of elderly men, levels of testosterone may dip excessively and result in symptoms ranging from decreased libido and impaired erectile function to muscle weakness and depressed mood. Additionally, many experience a reduction in vitality and energy along with an increased weight setting the stage for increased risk of diseases such as hypertension, hyperlipidemia, type 2 diabetes (T2D) as well as osteoarthritis and varicocele.
A recent analysis evaluated the impact of obesity, age and other parameters on androgen levels in older men. 875 men between the ages of 46-87 years participated in the study. Parameters such as weight, BMI, total and free testosterone (TT, FT), sex hormone binding globulin (SHBG), luteinizing hormone (LH), follicle-stimulating hormone (FSH) were measured.
Results from this study indicated:
- Obese patients had lower levels of TT, FT, and SHBG as compared to normal and underweight men
- Higher grades of obesity (grade 3), when compared to lower grades of obesity (grade 1 and 2) result in lower levels of TT and FT
- No statistical difference was found between obese and non-obese participants when looking at follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels
- Varicocele presence was not associated with BMI
- Varicocele presence did not impact serum levels of testosterone or SHBG
Regarding varicocele analysis, the presence and grade of varicocele had no impact on TT and SHBG. Patients with varicocele compared to patients without varicocele were similar regarding age, BMI and hormone levels.
The study’s authors noted several limitations to their findings including: not following patients over time (this was a cross sectional study), inability to review individual patient findings due to study design, and no measurements of estradiol which may have impacted the effect of BMI on hormone findings. Additionally, the ability of weight loss to change these outcomes was not assessed.
The results of this analysis do indicate an increase in BMI and obesity negatively affect sexual hormone levels in older males.
Why is this Clinically Relevant?
- According to the National Institutes of Health 36% of adult males are obese
- Obesity is a key player in androgen deficiency in males contributing to decreased libido, low vitality, muscle weakness, erectile dysfunction and depressed mood
- Obesity is a risk factor for cardiovascular and metabolic disease processes including heart disease and T2D as well as osteoarthritis and varicocele
- Reducing BMI may improve overall health, reproductive hormone balance and reduce risk factors for chronic disease in the adult and elderly male population
- Clinicians should counsel older male patients on the need for regular exercise and improved nutritional intake to attain or maintain appropriate BMI to improve long term outcomes
Yamacake KGR, et al. Impact of body mass index, age and varicocele on reproductive hormone profile from elderly men. Int Braz J Urol. 2016; 42:365-72.