Abstract
The prevalence of obesity continues to rise in adult and pediatric populations throughout the world. Obesity has a direct impact on all organ systems, including the reproductive system. This review summarizes current knowledge about the effects of obesity on the male reproductive system across age, highlighting the need for more data in children and adolescents. Male hypogonadism is commonly seen in patients with obesity and affects the onset, duration, and progression of puberty. Different pathophysiologic mechanisms include increased peripheral conversion of testosterone to estrone and increased inflammation due to increased fat, both of which lead to suppression of the hypothalamic-pituitary-gonadotropin (HPG) axis and delayed development of secondary sexual characteristics in adolescent males. Evaluation of the HPG axis in obesity includes a thorough history to exclude other causes of hypogonadism and syndromic associations. Evaluation should also include investigating the complications of low testosterone, including increased visceral fat, decreased bone density, cardiovascular disease risk, and impaired mood and cognition, among others. The mainstay of treatment is weight reduction, but medications such as testosterone and clomiphene citrate used in adults, remain scarcely used in adolescents. Male hypogonadism associated with obesity is common and providers who care for adolescents and young adults with obesity should be aware of its impact and management.
Highlights
Obesity has become a prominent chronic disease worldwide
Adolescents with hypogonadism present with few symptoms, unlike adults who may manifest many of the mentioned symptoms, and high clinical suspicion and further laboratory testing are required for male adolescent hypogonadism
A fasting early morning total testosterone is the initial test performed as adolescent males with obesity have significantly lower TT than adolescents without obesity [13,15]
Summary
Obesity has become a prominent chronic disease worldwide. In less than 45 years, the prevalence of obesity has tripled [1]. More than 1.9 billion adults and 381 million children and adolescents have overweight or obesity [1,2]. The prevalence of obesity in the United States is almost. 40% in adults and 19% in children and adolescents [3] This 19% translates into 13.7 million children and adolescents with obesity [3]. Adolescent obesity is defined as a body mass index (BMI) equal to or greater than the age and gender specific 95th percentile [4]. Factors leading to the development of adolescent obesity include genetic, neuroendocrine, socio-economic, psychological, metabolic and environmental factors [4]
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