Endocrine Abstracts

Objective: This systematic review aimed to assess the efficacy and safety of testosterone replacement therapy (TRT) in obese men with testosterone deficiency through the analysis of randomized controlled trials (RCTs).

Materials and Methods: A comprehensive computer-based search was conducted in Cochrane Library, PubMed, Embase, Web of Science, Scopus, Open SIGLE database, China National Knowledge Infrastructure (CNKI), Wanfang Data, VIP database, and China Biology Medicine (CBM) database to identify RCTs involving obese men with testosterone deficiency treated with TRT.

Results: A total of 10 RCTs, all published in English, were included in this study, involving 665 subjects at baseline. Meta-analysis demonstrated that, compared to the control group, TRT resulted in a decrease in body mass index (BMI) by 0.57 kg/m² (MD = -0.57, 95% CI: -0.94 to -0.20, P= 0.002), a reduction in waist circumference by 2.78 cm (MD = -2.78, 95% CI: -4.86 to -0.70, P= 0.009), an increase in lean body mass by 1.96 kg (MD = 1.96, 95% CI: 0.30 to 3.61, P= 0.027), a decrease in fasting blood glucose by 0.53 mmol/l (MD = -0.88, 95% CI: -0.88 to -0.19, P= 0.020), a decrease in HOMA-IR by 1.89 (MD = -1.89, 95% CI: -3.11 to -0.65, P= 0.003), a decrease in HbA1c by 0.52% (MD = -0.52, 95% CI: -0.82 to -0.22, P= 0.0006), and a decrease in triglycerides by 0.22 mmol/l (MD = -0.22, 95% CI: -0.36 to -0.07, P= 0.003). There were no statistically significant differences in body weight, body fat mass, non-fat body mass, total cholesterol (TC), LDL cholesterol (LDL-C), and HDL cholesterol (HDL-C) between the groups. SBP and DBP did not significantly increase after TRT compared to the control group. However, TRT was associated with a statistically significant increase in hematocrit (HCT) by 3.19% (MD = 3.19, 95% CI: 2.14 to 4.24, P<0.00001). The impact of TRT on PSA levels could not be conclusively determined.

Conclusion: The meta-analysis of randomized controlled trials suggests that testosterone replacement therapy in obese men with testosterone deficiency can improve metabolic parameters. TRT leads to reductions in BMI, waist circumference, and triglycerides, while increasing lean body mass and improving insulin resistance. There is no significant effect on blood pressure, but there is a risk of increased hematocrit. In clinical practice, it is recommended to carefully consider the indications for TRT and closely monitor cardiovascular risks.