Comparing effects of lifestyle modification-induced weight loss on androgen levels, endothelial, sexual and urinary function, and quality of life in obese men with and without androgen deficiency

J. Khoo; R. Chen; L. Cho; E. Tan; T. Tay; V. Au; S. Soh; B. Ng

Introduction: Androgen deficiency (AD) is associated with endothelial and erectile dysfunction, lower urinary tract symptoms (LUTS) and reduced quality of life (QoL) in obesity. We aimed to compare effects of weight loss induced by lifestyle modification on endothelial and erectile function, LUTS and QoL in obese men with and without AD.

Methods: abdominally obese Asian (body mass index≥30 kg/m², waist circumference [WC] ≧ 90 cm) men (mean age 43.1 years, range 30–61) with low libido were put on a weight loss program of caloric restriction (500 kilocalories/day below basal metabolic requirement) and moderate-intensity exercise (2000 kilocalories/week). Plasma sex-hormone binding globulin (SHBG) and total testosterone (TT), endothelial function (by Reactive Hyperaemia Index [RHI] using finger plethysmography on EndoPAT), International Index of Erectile Function 5-item (IIEF-5), Sexual Desire Inventory (SDI), International Prostate Symptom (IPSS) and 36-item Short Form Survey Instrument (SF-36) scores were measured at baseline and 12 weeks later. 34.2% (24/70) had AD, defined as TT <10.4 nmol/l.

Results (Table 1): At baseline, men with AD had significantly lower SDI score, TT, SHBG and calculated free testosterone (FT), and higher IPSS score, but similar age, weight, WC, RHI, IIEF−5 and SF−36 scores. Similar weight losses were seen in men with (4.2±3.4%) and without (4.0±3.1%) AD. Men with AD had significantly greater increases in TT (30.2 vs9.3%), FT (27.5 vs 5.5%), and SDI score (37.1 vs 13.1%), and decrease in IPSS score (31.6 vs 22.9%). Improvements in WC, RHI, SHBG, IIEF-5 and SF-36 scores were similar. TT normalized in ten men (41.7%) with AD.

Conclusions: Weight loss induced by diet and exercise improves endothelial, sexual and urinary function, quality of life and sex hormones in obese men regardless of androgen status, with significantly greater improvements in testosterone, sexual desire and LUTS particularly in androgen-deficient men.

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This work was supported, however funding details unavailable.

**Table 1** Changes in anthropometry, sexual function, LUTS, sex hormones, sexual and endothelial function and LUTS after 12 weeks of lifestyle modifcation.
	Androgen deficient (n=24) Mean ± S.D.	Not androgen deficient (n=46) Mean ± S.D.	P value
Baseline age (years)	46.1±9.2	41.6±7.5	0.05
Baseline BMI (kg/m²)	32.8±2.8	31.7±3.4	0.18
Baseline weight (kg)	98.6±9.7	94.7±10.8	0.14
Baseline WC (cm)	106.9±6.7	104.4±7.6	0.17
Baseline TT (nmol/L)	8.09±1.76	14.66±3.21	< 0.001
Baseline SHBG (nmol/l)	21.00±8.29	27.81±9.04	0.003
Baseline FT (pmol/l)	202±53	337±75	<0.001
Baseline IIEF-5	17.8±5.3	18.6±5.4	0.53
Baseline SDI	43.0±20.4	54.2±17.8	0.03
Baseline IPSS	6.8±4.8	4.1±3.2	0.01
Baseline RHI	1.77±0.42	1.96±0.63	0.13
Baseline SF-36 (physical component)	45.5±6.8	47.3±8.0	0.31
Baseline SF-36 (mental component)	48.8±7.3	49.2±8.2	0.84
Δ weight (%)	−4.2±3.4	−4.0±3.1	0.71
Δ WC (%)	−2.7±2.2	−3.7±2.8	0.07
Δ TT (%)	30.2±36.5	9.3±18.4	0.002
Δ SHBG (%)	9.9±16.4	10.1±13.8	0.95
Δ FT (%)	27.5±34.8	5.5±18.3	0.001
Δ IIEF-5 (%)	19.7±24.0	13.8±25.7	0.34
Δ SDI (%)	37.1±50.9	13.1±25.2	0.01
Δ IPSS (%)	−31.6±30.4	−22.9±57.2	0.04
Δ RHI (%)	25.8±30.1	23.3±33.1	0.75
Δ SF-36 (physical component) (%)	12.1±13.4	11.7±19.4	0.91
Δ SF-36 (mental component) (%)	11.3±10.1	9.3±2.4	0.58

Endocrine Abstracts

P1240