AACE and ACE obesity guidelines recommend assessment of hypogonadism in men with obesity, elevated waist circumference, and/ or diabetes, and treatment if indicated.


Of 823 men with hypogonadism from a single urology center, 69 had excessive obesity (BMI≥40 kg/m²). 52 opted for testosterone therapy (TTh, T-group) and received 3-monthly injections of testosterone undecanoate (TU), 17 against TTh (CTRL). 11-year results were analyzed. Differences between groups were adjusted for age and components of the metabolic syndrome.


Mean age: T-group: 61.9±4.9, CTRL: 60±5.3 years, mean follow-up 7.7±3.1, median 8 years. In the T-group, weight decreased by 31.1±0.6 kg at 11 (p<0.0001) and increased in CTRL by 3.7±2.7 kg at 10 years (NS). The per cent weight reduction in the T-group was 24.2±0.5% (p<0.0001), the increase in CTRL was 4.2±2.0% (p<0.05)In the T-group, waist circumference decreased by 15.9±0.4 cm (p<0.0001) and increased in CTRL by 6.5±1.7 cm (p<0.0005).In the T-group, BMI decreased by 10.2±0.2 kg/m² (p<0.0001) and increased in CTRL by 1.4±0.9 kg/m² (NS).In the T-group, waist:height ratio decreased by 0.09±0.0 (p<0.0001) and increased in CTRL by 0.04±0.0 (p<0.0005).In the T-group, reductions in weight and waist circumference were statistically significant compared to the previous year for the first 9 years, Adverse events: In the T-group, 6 patients (11.5%) died of non-cardiovascular events. There were no non-fatal major adverse cardiovascular events (MACE). In CTRL, 8 patients (47.1%) died, 8 (47.1%) had a non-fatal myocardial infarction, and 8 (47.1%) a non-fatal stroke. Medication adherence in the T-group was 100 per cent as all injections were performed in the office and documented.


Long-term treatment with testosterone in men with hypogonadism and excessive obesity resulted in weight loss comparable to bariatric surgery. Mortality and MACE were higher in the control group.