title: Hypogonadism as an additional indication for bariatric surgery in male morbid obesity?
abstract: OBJECTIVE
  Male obesity is often associated with reduced levels of circulating total (TT) and calculated free testosterone (cFT), with normal/reduced gonadotropins. Bariatric surgery often improves sex steroid and sex hormone-binding globulin (SHBG) levels. The aim of this study was to assess the effects of bariatric surgery on waist circumference (WC) and BMI, and on TT levels, in morbidly obese men, stratified, according to the gonadal state, in eugonadal and hypogonadal (TT<8 nmol/l) subjects.
  
  
  METHODS
  A cohort of morbidly obese patients (29 with hypogonadism (HG) and 26 without) undergoing bariatric surgery (37, 10, 6, and 2, with Roux-en-Y gastric bypass, laparoscopic adjustable gastric banding, biliopancreatic diversion and gastric sleeve, respectively) was studied at 6 and 12 months from the operation.
  
  
  METHODS
  Anthropometric parameters (weight, BMI, WC) and sex hormones (gonadotropins, TT, cFT, estradiol (E2), SHBG) were assessed.
  
  
  RESULTS
  WC was the only parameter significantly correlated with androgens, but not with E2, SHBG, and gonadotropins, at baseline. After surgery, a significant increase in TT, cFT, and SHBG, accompanied by a decrease in E2, was evident in the two groups. However, both TT and cFT, but not E2, SHBG, and gonadotropin variations, were significantly higher in the hypogonadal group at follow-up, with an overall 93% complete recovery from HG. Reduction in WC, but not BMI, was significantly greater in hypogonadal men (ΔWC=-29.4±21.6 vs -14.4±17.4 at 12 months, P=0.047).
  
  
  CONCLUSIONS
  Recovery from obesity-associated HG is one of the beneficial effects of bariatric surgery in morbidly obese men. The present findings suggest that the gonadal state is a predictor of WC decrease after bariatric surgery.
authors.affiliation: Endocrinology UnitDepartment of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, ItalyBariatric and Metabolic SurgeryCareggi HospitalDiabetes AgencyAzienda Ospedaliera-Universitaria Careggi, Florence, ItalySexual Medicine and Andrology UnitDepartment of Experimental and Clinical Biomedical Sciences, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy.
authors.forename: Jinous
authors.initials: J
authors.lastname: Samavat
authors.affiliation: Endocrinology UnitDepartment of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, ItalyBariatric and Metabolic SurgeryCareggi HospitalDiabetes AgencyAzienda Ospedaliera-Universitaria Careggi, Florence, ItalySexual Medicine and Andrology UnitDepartment of Experimental and Clinical Biomedical Sciences, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Facchiano
authors.affiliation: Endocrinology UnitDepartment of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, ItalyBariatric and Metabolic SurgeryCareggi HospitalDiabetes AgencyAzienda Ospedaliera-Universitaria Careggi, Florence, ItalySexual Medicine and Andrology UnitDepartment of Experimental and Clinical Biomedical Sciences, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy.
authors.forename: Marcello
authors.initials: M
authors.lastname: Lucchese
authors.affiliation: Endocrinology UnitDepartment of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, ItalyBariatric and Metabolic SurgeryCareggi HospitalDiabetes AgencyAzienda Ospedaliera-Universitaria Careggi, Florence, ItalySexual Medicine and Andrology UnitDepartment of Experimental and Clinical Biomedical Sciences, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy.
authors.forename: Gianni
authors.initials: G
authors.lastname: Forti
authors.affiliation: Endocrinology UnitDepartment of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, ItalyBariatric and Metabolic SurgeryCareggi HospitalDiabetes AgencyAzienda Ospedaliera-Universitaria Careggi, Florence, ItalySexual Medicine and Andrology UnitDepartment of Experimental and Clinical Biomedical Sciences, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy.
authors.forename: Edoardo
authors.initials: E
authors.lastname: Mannucci
authors.affiliation: Endocrinology UnitDepartment of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, ItalyBariatric and Metabolic SurgeryCareggi HospitalDiabetes AgencyAzienda Ospedaliera-Universitaria Careggi, Florence, ItalySexual Medicine and Andrology UnitDepartment of Experimental and Clinical Biomedical Sciences, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy mario.maggi@unifi.it.
authors.forename: Mario
authors.initials: M
authors.lastname: Maggi
authors.affiliation: Endocrinology UnitDepartment of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, ItalyBariatric and Metabolic SurgeryCareggi HospitalDiabetes AgencyAzienda Ospedaliera-Universitaria Careggi, Florence, ItalySexual Medicine and Andrology UnitDepartment of Experimental and Clinical Biomedical Sciences, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy.
authors.forename: Michaela
authors.initials: M
authors.lastname: Luconi
mesh_terms: D000328:Adult; D050110:Bariatric Surgery / Q000706:statistics & numerical data; D015992:Body Mass Index; D015331:Cohort Studies; D006801:Humans; D007006:Hypogonadism / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D011379:Prognosis; D055105:Waist Circumference