我们检查了体重减轻对总(TT)和游离睾丸激素(FT)水平的影响,并构造列线图,为临床医生提供易于使用的视觉辅助。使用RevMan(v5.3)进行荟萃分析,并以睾酮的标准化平均差异(SMD)表示。根据基线和目标BMI值构建平行比例列线图,以估计睾丸激素的增加。总的来说,包括44项研究,包括1,774名参与者和2,159个数据集,因为一些研究包括不同时间点的几个数据集。在19项研究中,体重减轻是通过低热量饮食(LCD)控制的(735名参与者,988个数据集),在26项研究中通过减肥手术(BS)(1039名参与者,1,171个数据集),两者都在一项研究中。中位随访时间为26周(四分位距=12-52)。基线平均年龄为21-68岁,BMI:26.2-71.2kg/m2,TT:7-20.2nmol/l,FT:140-583pmol/l。通过LCD:SMD(95CI)=2.5nmol/l(1.9-3.1)和BS:SMD=7.2nmol/l(6.0-8.4)减轻体重后,TT水平增加;合并的TT增益为4.8nmol/l(3.9-5.6)。通过LCD:SMD=19.9pmol/l(7.3-32.5)和BS:SMD=58.0pmol/l(44.3-71.7)减轻体重后,FT水平增加;合并增益为42.2pmol/l(31.4-52.9)。基线BMI较高的男性可以通过体重减轻获得更多的总睾酮和游离睾酮。或较低水平的SHBG,TT和FT,而年龄较大的TT增加相对较大,年龄较小的FT增加相对较大。年龄分层列线图显示,与老年男性(>40岁)相比,对于给定的体重减轻,年轻男性(≤40岁)的TT增加较少,但FT增加。总之,减肥后TT和FT水平都增加了,较高的基线BMI相对较大,或较低水平的SHBG,TT和FT。由大量具有广泛BMI和睾丸激素值的参与者构建的列线图在临床实践中提供了基于证据且易于使用的工具。本文受版权保护。保留所有权利。
BACKGROUND: Obesity-induced hypogonadism, which manifests as erectile dysfunction and a lack of libido, is a less visible and under-recognized obesity-related disorder in men.
OBJECTIVE: We examined the impact of weight loss on total (TT) and free testosterone (FT) levels, and constructed nomograms to provide an easy-to-use visual aid for clinicians.
METHODS: Meta-analysis was conducted using RevMan (v5.3) and expressed in standardized mean differences (SMD) for testosterone. Parallel-scale nomograms were constructed from baseline and target body mass index values to estimate the gain in testosterone.
RESULTS: In total, 44 studies were included, comprising 1,774 participants and 2,159 datasets, as some studies included several datasets at different time points. Weight loss was controlled by low calorie diet (LCD) in 19 studies (735 participants, 988 datasets), by bariatric surgery (BS) in 26 studies (1,039 participants, 1,171 datasets), and by both in one study. The median follow-up was 26 weeks (interquartile range = 12-52). The range of baseline mean age was 21-68 yr, BMI: 26.2-71.2 kg/m2 , TT: 7-20.2 nmol/L and FT: 140-583 pmol/L. TT levels increased after weight loss by LCD: SMD (95%CI) = 2.5 nmol/L (1.9-3.1) and by BS: SMD = 7.2 nmol/L (6.0-8.4); the combined TT gain was 4.8 nmol/L (3.9-5.6). FT levels increased after weight reduction by LCD: SMD = 19.9 pmol/L (7.3-32.5) and by BS: SMD = 58.0 pmol/L (44.3-71.7); the combined gain was 42.2 pmol/L (31.4-52.9). Greater amounts of total and free testosterone could be gained by weight loss in men with higher baseline BMI, or lower levels of SHBG, TT and FT, while gain in TT was relatively greater in older and FT in younger age. Age-stratified nomograms revealed that compared to older men (> 40 yr), younger men (≤ 40 yr) gained less TT but more FT for a given weight loss.
CONCLUSIONS: Both TT and FT levels increased after weight loss, relatively greater with higher baseline BMI, or lower levels of SHBG, TT and FT. Nomograms constructed from a large number of participants with a wide range of BMI and testosterone values provide an evidence-based and simple-to-use tool in clinical practice.