Objective: This systematic review aimed to assess the efficacy and safety of testosterone replacement therapy (TRT) in obese men with testosterone deficiency.
Materials and Methods: A comprehensive computer-based search was conducted in Cochrane Library, PubMed, Embase, Web of Science, Scopus, Open SIGLE database, China National Knowledge Infrastructure, Wanfang Data, VIP database, and China Biology Medicine database to identify RCTs involving obese men with testosterone deficiency treated with TRT. Methodological quality was assessed using the risk of bias assessment tool in RevMan 5.3.
Results: A total of 10 RCTs were included, involving 665 subjects at baseline. Meta-analysis demonstrated that TRT resulted in a decrease in BMI by 0.57 kg/m²(P=0.002), a reduction in waist circumference(WC) by 2.78 cm(P=0.009), an increase in lean body mass by 1.96 kg(P=0.027), a decrease in fasting blood glucose by 0.53 mmol/L(P=0.002), a decrease in HOMA-IR by 1.89 (P=0.003), a decrease in HbA1c by 0.52% (P=0.0006), and a decrease in triglycerides(TG) by 0.22 mmol/L(P=0.003). There were no statistically differences in body weight, body fat mass, non-fat body mass, total cholesterol, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol between the groups. However, TRT was associated with a statistically increase in hematocrit by 3.19% (P<0.00001).
Conclusions: The study suggests that testosterone replacement therapy in obese men with testosterone deficiency can improve metabolic parameters. TRT leads to reductions in BMI, WC and TG, while increasing lean body mass and improving insulin resistance. There is a risk of increased hematocrit, and it is recommended to consider the indications for TRT and cardiovascular risks. These findings suggest a potential role for TRT in the broader management strategy for obesity-related metabolic disorders.
Y. Liu: None. M. Zhang: None. Z. Fan: None. T. Wang: None.
