Obesity has become one of the most important public health problems. Considered as one of the many adverse consequences of overweight and obesity, the maleobesity-associatedsecondary hypogonadism (MOSH) is a very prevalent and undervalued condition. Is characterized by low total testosterone (TT) levels associated to low or inappropriately normal luteinizing hormone (LH) and follicle-stimulating hormone (FSH). Increased aromatase activity, imbalance in the testosterone/estradiol ratio and the state of low-grade inflammation are the major factors involved. Low levels of testosterone may have important long-term negative health consequences, related to earlier death owing to cardiovascular disease and all causes. Low testosterone levels contribute to increase in fat mass and waist circumference, aggravating obesity. Increased aromatase activity, imbalance in the testosterone/estradiol ratio and the state of low-grade inflammation are the major factors involved. Current evidence supports the association between the fast loss of weight following bariatric surgery and reversal of hypogonadism, associated to obesity, while a hypocaloric diet and lifestyle change does not produce the same results. As an alternative for non-invasive substantial weight loss, very low-calorie ketogenic diet (VLCK) provide similar results as bariatric surgery. When used under proper medical supervision, is safe and effective in promoting significant short-term weight loss, with concomitant improvement in obesity-related conditions. In this report, we describe clinical and laboratorial features of 4 obese man with metabolic syndrome (MS) and MOSH, who had a significant improvement in metabolic and hormonal parameters after VLCK. Pre and post-treatment parameters are described below: P1- 42y, VLCK 28 days; Weight 98/87; BMI 30,2/26,8; Fat% 23,2/17,8%; waist circumference (WC) 119,5/109 cm, Triglicerides 202/118; HDL 38/41; HOMA IR 3,38/2,15; Total testosterone (TT)215/440; E2 40,9/33,3. P2- 47y, VLCK 112 days; Weight 106,4/83,1; BMI 33,9/26,5; Fat% 28,8/24,3%; waist circumference (WC) 120/97 cm, Triglicerides 162/78; HDL 33/39; HOMA IR 4,54/1,9; Total testosterone (TT)287/575; E2 0,9/4,1. P3- 42y, VLCK 120days; Weight 128/95,8; BMI 43,7/32,8; Fat% 50,7/40%; waist circumference (WC) 120/97 cm, Triglicerides 160/80; HDL 25/43; HOMA IR 6,7/2,0; Total testosterone (TT) 275/598; E2 6,0/3,6. P4- 42y, VLCK 90 days; Weight 96,2/83,1; BMI 30,7/32,8; Fat% 28,3/18,9%; waist circumference (WC) 106/95 cm, Triglicerides 372/135; HDL 31/39; HOMA IR 5,12/2,5; Total testosterone (TT)273/479; E2 3,3/3,6.
Conclusion: VLCK appears to be a promissing method to improve testosterone levels in obese hypogonadal men. Further larger controled studies are required.
18 - 21 May 2019
European Society of Endocrinology