The effects of bariatric surgery on testosterone levels in men with obesity and hypogonadism have not been thoroughly explored yet. To investigate the possible effects of bariatric surgery on T levels in obese hypogonadal men by comparing T levels before and after surgery using a comprehensive claims database. The TriNetX US Collaborative Network database was used to identify men ages 18-80 who underwent a bariatric procedure and had a serum T value of<350ng/dL prior to surgery. Men who received testosterone therapy before/or after surgery were excluded. We conducted a retrospective self-matched cohort analysis to examine the difference in serum T levels before and after bariatric surgery. A sub-analysis was carried out to explore differences between men who reached eugonadal status or maintained low T levels following surgery. Descriptive statistics detailed sociodemographic and clinical characteristics, with continuous and categorical data compared using unpaired t-tests and chi-square analysis, respectively. Changes in T levels and body mass index (BMI) before and after surgery were compared using an unpaired t-test with a<0.05 set for significance. All analyses were conducted using the TriNetX platform which utilizes both Python and R software. The study analyzed 69 hypogonadal men who underwent bariatric surgery and had T levels assessed before and after the procedure. The mean (standard deviation) pre-surgery serum T level was 208±79ng/dL, which post-surgery increased to 371±164ng/dL, marking an average increase of 163±164ng/dL. Likewise, the mean (standard deviation) body mass index decreased from 42.9±9.0 to 38.8±5.7kg/m2. Post-surgery, 45% (31 men) achieved eugonadal status, while 55% (38 men) continued to have low T levels. A comparison between the post-surgery eugonadal cohort and the persistent low T cohort revealed that the former had higher pre-surgery serum T levels (235±71ng/dL vs. 184±80.4ng/dL, p=0.007), a higher pre-surgery body mass index (45.5±4.5kg/m2 vs. 41.1±11.5kg/m2, p=0.041), and a significantly greater reduction in body mass index post-surgery (7.3±7.2kg/m2 vs. 2.0±12.8kg/m2, p=0.04). Notably, the increase in T was significantly higher in the eugonadal cohort compared to the persistent low testosterone cohort (257±143ng/dL vs. 95±178ng/dL, p<0.0001). This study provides evidence of bariatric surgery's positive effect on serum T levels in obese men with baseline low T. Almost one out of two men with low T reached normal T levels after bariatric surgery. As the most comprehensive study to date, it validates and substantiates previous work suggesting that weight loss can improve T levels physiologically.
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