Endocrine Abstracts

Obesity is the single most significant risk factor for testosterone deficiency in men, with a reported prevalence up of 60% of male obesity secondary hypogonadism (MOSH). Several studies have shown that significant weight loss due to bariatric surgery have significant metabolic and endocrine improvement in obesity, however the results achieved with conventional diet and lifestyle change are poor and not able to reverse this condition. As an alternative to bariatric surgery, we aimed to evaluate the effect of very low-calorie ketogenic dietary (VLCKD) on hypogonadism reversion and sexual function in obese patients. Ten men aged 31–47 years with BMI between 31.7–48.7 kg/m² were assigned to the VLCKD intervention following a commercial program of weight loss Pronokal Method. Body weight, visceral fat, HOMA-IR, triglycerides, HDL and testosterone levels were measured at baseline and after two months. International Index of Erectile Function (IIEF–5) questionnaire was used to assess erectile dysfunction at baseline and after six months. Statistical analysis was performed by repeated-measure multivariate ANOVA using STATA 14.2. Results demonstrated mean weight loss of 18.0 ± 3.2 kg (15 ± 2.1%) with a significant improvement in TT levels (150.4 ± 127 ng/dl corresponding to 53 ± 38.9% of the basal; P = 0.005). IIEF-5 score of six patients was calculated. Four had erectile dysfunction that improved from mild to normal (n = 3) and from severe to mild/moderate (n = 1). Furthermore, a significant improvement in metabolic parameters as HDL, triglycerides, HOMA-IR and visceral adiposity were also reported. Compared to data found in meta-analysis (increase of 254 ng/dl/32% of weight reduction), the VLCKD diet seems to increase more significantly baseline testosterone levels. In conclusion, VLCKD significantly increases testosterone levels, improves metabolic parameters and erectile function in men.