Oral Presentation Annual Meetings of the Endocrine Society of Australia and Society for Reproductive Biology and Australia and New Zealand Bone and Mineral Society 2016

Dieting but not testosterone treatment improves androgen deficiency-like symptoms in obese men with lowered testosterone (#114)

Mark Ng Tang Fui 1 2 , Luke A Prendergast 1 3 , Philippe Dupuis 1 , Jeffrey D Zajac 1 2 , Mathis Grossmann 1 2
  1. Medicine, University of Melbourne, Heidelberg, Victoria, Australia
  2. Austin Health, Heidelberg, Victoria, Australia
  3. Mathematics and Statistics, La Trobe University, Melbourne, Victoria, Australia

Importance: Obese men with modest reductions in circulating testosterone commonly report non-specific symptoms consistent with androgen-deficiency. Whether testosterone treatment leads to improvements in androgen deficiency-like symptoms over and above the effects of dieting is unknown.

Objective: To determine whether testosterone treatment improves androgen deficiency-like symptoms among dieting men.

Design: Secondary analysis of a randomised double-blind, placebo-controlled trial.

Participants: Obese men with a total testosterone level <12nmol/L.

Intervention: 100participants receiving 10 weeks of a very low energy diet (VLED) followed by weight maintenance were randomisedat baseline to 56 weeks of intramuscular testosterone undecanoate (n=49, cases) or placebo (n=51, controls).

Main Outcomes: The pre-specified outcomes were the between-group differences in Aging male symptoms score (AMS) and international index of erectile function (IIEF).

Results: Cases and controls lost the same weight after VLED (testosterone -12.0kg; placebo -13.5kg, p=0.40) and maintained this at study end  (testosterone -11.4kg; placebo -10.9kg, p=0.80). There was no difference in AMS between groups after VLED (mean adjusted difference (MAD) -0.44, 95% CI -4.6; 3.8, p = 0.84) or at study end (MAD -1.7, 95% CI -6.2; 2.7, p = 0.44). Both cases and controls had improvements in AMS by approximately 20% after VLED (cases from 35.6 to 27.3 and controls from 34.6 to 27.9, both p < 0.05) which was maintained in cases (improved by 4.6 points, p = 0.006 relative to baseline) but not controls (improved by 2.3 points, p = 0.131) compared to baseline. Men had mild erectile dysfunction at baseline (IIEF cases 20.0, controls 19.3), with no between or within group differences during the study.


Conclusions: In relatively healthy obese men, androgen deficiency-like symptoms are primarily a consequence of excess weight rather than due to their reduced testosterone levels. For symptomatic benefit, weight loss rather than testosterone treatment should be the first line approach.