title: Age-related changes in general and sexual health in middle-aged and older men: results from the European Male Ageing Study (EMAS). Surgical vs conventional therapy for weight loss treatment of obstructive sleep apnea: a randomized controlled trial. Circulating free testosterone in obese men after bariatric surgery increases in parallel with insulin sensitivity Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies Sex hormones and sexual function in obese men losing weight. Effects of bariatric surgery on mortality in Swedish obese subjects. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. Endocrine aspects of male sexual dysfunctions. Erectile dysfunction and hormonal imbalance in morbidly obese male is reversed after gastric bypass surgery: a prospective randomized controlled trial. Sex hormone-binding globulin levels and cardiovascular risk factors in morbidly obese subjects before and after weight reduction induced by diet or malabsorptive surgery. Body composition and hormonal responses to a carbohydrate-restricted diet. Hypothalamic-pituitary-testicular axis disruptions in older men are differentially linked to age and modifiable risk factors: the European Male Aging Study. Letrozole once a week normalizes serum testosterone in obesity-related male hypogonadism. Male sexuality and cardiovascular risk. A cohort study in patients with erectile dysfunction. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. Influence of exercise training on physiological and performance changes with weight loss in men.
abstract: INTRODUCTION Limited information is available concerning the general and sexual health status of European men . AIM To investigate the age-related changes in general and sexual health in middle-aged and older men from different countries of the European Union . METHODS This is a cross-sectional multicenter survey performed on a sample of 3,369 community-dwelling men aged 40 - 79 years old ( mean 60 + or - 11 years ) . Subjects were r and omly selected from eight European centers including centers from nontransitional ( Florence [ Italy ] , Leuven [ Belgium ] , Malmö[Sweden ] , Manchester [ United Kingdom ] , Santiago de Compostela [ Spain ] ) and transitional countries ( Lodz [ Pol and ] , Szeged [ Hungary ] , Tartu [ Estonia ] ) . MAIN OUTCOME MEASURES Different parameters were evaluated including the Beck 's Depression Inventory for the quantification of depressive symptoms , the Short Form-36 Health Survey for the assessment of the quality of life ( QoL ) , the International Prostate Symptom Score for the evaluation of lower urinary tract symptoms , and the European Male Ageing Study sexual function question naire for the study of sexual function . RESULTS More than 50 % of subjects reported the presence of one or more common morbidities . Overall , hypertension ( 29 % ) , obesity ( 24 % ) , and heart diseases ( 16 % ) were the most prevalent conditions . Around 30 % of men reported erectile dysfunction ( ED ) and 6 % reported severe orgasmic impairment , both of which were closely associated with age and concomitant morbidities . Only 38 % of men reporting ED were concerned about it . Furthermore , concern about ED increased with age , peaking in the 50 - 59 years age b and , but decreased thereafter . Men in transitional countries reported a higher prevalence of morbidities and impairment of sexual function as well as a lower QoL. CONCLUSION Sexual health declined while concomitant morbidities increased in European men as a function of age . The burden of general and sexual health is higher in transitional countries , emphasizing the need to develop more effective strategies to promote healthy aging for men in these countries CONTEXT Obstructive sleep apnea ( OSA ) is strongly related to obesity . Weight loss is recommended as part of the overall management plan for obese patients diagnosed with OSA . OBJECTIVE To determine whether surgically induced weight loss is more effective than conventional weight loss therapy in the management of OSA . DESIGN , SETTING , AND PATIENTS A r and omized controlled trial of 60 obese patients ( body mass index : > 35 and < 55 ) with recently diagnosed ( < 6 months ) OSA and an apnea-hypopnea index ( AHI ) of 20 events/hour or more . These patients had been prescribed continuous positive airway pressure ( CPAP )  therapy to manage OSA and were identified via accredited community sleep clinics . The trial was conducted between September 2006 and March 2009 by university- and teaching hospital-based clinical research ers in Melbourne , Australia . Patients with obesity hypoventilation syndrome , previous bariatric surgery , contraindications to bariatric surgery , or significant cardiopulmonary , neurological , vascular , gastrointestinal , or neoplastic disease were excluded . INTERVENTIONS Patients were r and omized to a conventional weight loss program that included regular consultations with a dietitian and physician , and the use of very low-calorie diets as necessary ( n = 30 ) or to bariatric surgery ( laparoscopic adjustable gastric b and ing ; n = 30 ) . MAIN OUTCOME MEASURES The primary outcome was baseline to 2-year change in AHI on diagnostic polysomnography scored by staff blinded to r and omization . Secondary outcomes were changes in weight , CPAP adherence , and functional status . RESULTS Patients lost a mean of 5.1 kg ( 95 % CI , 0.8 to 9.3 kg ) in the conventional weight loss program compared with 27.8 kg ( 95 % CI , 20.9 to 34.7 kg ) in the bariatric surgery group ( P < .001 ) . The AHI decreased by 14.0 events/hour ( 95 % CI , 3.3 to 24.6 events/hour ) in the conventional weight loss group and by 25.5 events/hour ( 95 % CI , 14.2 to 36.7 events/hour ) in the bariatric surgery group . The between-group difference was -11.5 events/hour ( 95 % CI , -28.3 to 5.3 events/hour ; P = .18 ) . CPAP adherence did not differ between the groups . The bariatric surgery group had greater improvement in the Short Form 36 physical component summary score ( mean , 9.3 [ 95 % CI , 0.5 to 18.0 ] ; P = .04 ) . CONCLUSION Among a group of obese patients with OSA , the use of bariatric surgery compared with conventional weight loss therapy did not result in a statistically greater reduction in AHI despite major differences in weight loss . TRIAL REGISTRATION anzctr.org Identifier : 12605000161628 Background and aim : Male hypogonadism has been linked to obesity and diabetes . We aim ed to study the association of changes in insulin sensitivity and testosterone levels in severe obese patients su bmi tted to bariatric surgery .  Subjects and methods : Prospect i ve intervention study with twenty consecutive patients who underwent bariatric surgery studied before and after significant weight loss .  Serum testosterone , SHBG , fasting glucose , and insulin were measured among others . Free testosterone was calculated with the Vermeulen formula and insulin sensitivity with the homeostatic model assessment ( HOMA ) . Results : At baseline , thirteen patients had low total testosterone levels  , whereas eight of these patients also had free testosterone levels below the reference range obtained from the control group . After bariatric surgery  total testosterone , SHBG , and free testosterone significantly increased and achieved normal values in all evaluated patients . Insulin sensitivity improved in all of them . Multivariate linear regression showed that changes in fasting glucose ( β=−1.868 , p= 0.001 ) , insulin ( β=−3.782 , p= 0.001 ) , weight ( β=−0.622 , p= 0.002 ) , and SHBG ( β=−0.635 , p= 0.022 ) were associated with changes in free testosterone ( adjusted R2 = 0.936 , F=26.613 , p= 0.001 ) . When insulin resistance calculated by HOMA was in the model instead of insulin and glucose , it also was associated ( β=−3.488 , p= 0.008 ) with free testosterone ( adjusted R2 = 0.821 , F=11.111 , p= 0.005 ) . Conclusion : Circulating testosterone in obese men increases after bariatric surgery in parallel with an improvement in insulin sensitivity Summary Background The main associations of body-mass index ( BMI ) with overall and cause-specific mortality can best be assessed by long-term prospect i ve follow-up of large numbers of people . The Prospect i ve Studies Collaboration aim ed to investigate these associations by sharing data from many studies . Methods Collaborative analyses were undertaken of  baseline BMI versus mortality  in 57 prospect i ve studies with 894 576 participants , mostly in western Europe and North America ( 61 % [ n=541 452 ] male , mean recruitment age 46 [ SD 11 ] years , median recruitment year 1979 [ IQR 1975–85 ] , mean BMI 25 [ SD 4 ] kg/m2 ) . The analyses were adjusted for age , sex , smoking status , and study . To limit reverse causality , the first 5 years of follow-up were excluded , leaving 66 552 deaths of known cause during a mean of 8 ( SD 6 ) further years of follow-up ( mean age at death 67 [ SD 10 ] years ) : 30 416 vascular ; 2070 diabetic , renal or hepatic ; 22 592 neoplastic ; 3770 respiratory ; 7704 other . Findings In both sexes , mortality was lowest at about 22·5–25 kg/m2 . Above this range , positive associations were recorded for several specific causes and inverse associations for none , the absolute excess risks for higher BMI and smoking were roughly additive , and each 5 kg/m2 higher BMI was on average associated with about 30 % higher overall mortality ( hazard ratio per 5 kg/m2 [ HR ] 1·29 [ 95 % CI 1·27–1·32 ] ) : 40 % for vascular mortality ( HR 1·41 [ 1·37–1·45 ] ) ; 60–120 % for diabetic , renal , and hepatic mortality ( HRs 2·16 [ 1·89–2·46 ] , 1·59 [ 1·27–1·99 ] , and 1·82 [ 1·59–2·09 ] , respectively ) ; 10 % for neoplastic mortality ( HR 1·10 [ 1·06–1·15 ] ) ; and 20 % for respiratory and for all other mortality ( HRs 1·20 [ 1·07–1·34 ] and 1·20 [ 1·16–1·25 ] , respectively ) . Below the range 22·5–25 kg/m2 , BMI was associated inversely with overall mortality , mainly because of strong inverse associations with respiratory disease and lung cancer . These inverse associations were much stronger for smokers than for non-smokers , despite cigarette consumption per smoker varying little with BMI . Interpretation Although other anthropometric measures ( eg , waist circumference , waist-to-hip ratio ) could well add extra information to BMI , and BMI to them , BMI is in itself a strong predictor of overall mortality both above and below the apparent optimum of about 22·5–25 kg/m2 . The progressive excess mortality above this range is due mainly to vascular disease and is probably largely causal . At 30–35 kg/m2 , median survival is reduced by 2–4 years ; at 40–45 kg/m2 , it is reduced by 8–10 years ( which is comparable with the effects of smoking ) . The definite excess mortality below 22·5 kg/m2 is due mainly to smoking-related diseases , and is not fully explained . Funding UK Medical Research Council , British Heart Foundation , Cancer Research UK , EU BIOMED programme , US National Institute on Aging , and Clinical Trial Service Unit ( Oxford , UK ) OBJECTIVE To study the impact of a weight-loss program on sex hormones and sexual function among 38 middle-aged obese men ( BMI > or=35 kg/m(2 ) ) . RESEARCH METHODS AND PROCEDURES A r and omized controlled clinical trial was conducted . The treatment group ( n = 19 ) participated in a 4-month weight-loss program including 10 weeks on a very-low-energy diet ( VLED ) and 17 behavior modification visits . There was no intervention in the control  group ( n = 19 ) . Both groups were followed for 8 months , i.e. , 22 weeks after the active weight loss in the treatment group . The outcome measures ( weight , sex hormones , sexual function , leptin , and metabolic variables ) were obtained at baseline and at three time-points during follow-up . RESULTS The mean weight loss in the treatment group was 21 kg at the end of the 10-week VLED . At the end of follow-up , the maintained weight loss was 17 kg of baseline weight . The control group was weight stable throughout the study . In the treatment group , increases in sex hormone-binding globulin , testosterone , and high-density lipoprotein-cholesterol , as well as decreases in insulin and leptin , were maintained until the end of follow-up , although with VLED , the level of several hormones and metabolic variables improved transiently during the rapid weight loss . There were no significant changes in the question naire scores on sexual function in either group . DISCUSSION We conclude that obese men lose weight and increase their serum testosterone level on a weight-loss program with VLED and behavior modification . However , they do not change their sexual function scores BACKGROUND Obesity is associated with increased mortality . Weight loss improves cardiovascular risk factors , but no prospect i ve interventional studies have reported whether weight loss decreases overall mortality . In fact , many observational studies suggest that weight reduction is associated with increased mortality . METHODS The prospect i ve , controlled Swedish Obese Subjects study involved 4047 obese subjects . Of these subjects , 2010 underwent bariatric surgery ( surgery group ) and 2037 received conventional treatment ( matched control group ) .  We report on overall mortality during an average of 10.9 years of follow-up . At the time of the analysis ( November 1 , 2005 ) , vital status was known for all but three subjects ( follow-up rate , 99.9 % ) . RESULTS The average weight change in control subjects was less than + /-2 % during the period of up to 15 years during which weights were recorded . Maximum weight losses in the surgical subgroups were observed after 1 to 2 years : gastric bypass , 32 % ; vertical-b and ed gastroplasty , 25 % ; and b and ing , 20 % . After 10 years , the weight losses from baseline were stabilized at 25 % , 16 % , and 14 % , respectively . There were 129 deaths in the control group and 101 deaths in the surgery group . The unadjusted overall hazard ratio was 0.76 in the surgery group ( P=0.04 ) , as compared with the control group , and the hazard ratio adjusted for sex , age , and risk factors was 0.71 ( P=0.01 ) . The most common causes of death were myocardial infa rct ion ( control group , 25 subjects ; surgery group , 13 subjects ) and cancer ( control group , 47 ; surgery group , 29 ) . CONCLUSIONS Bariatric surgery for severe obesity is associated with long-term weight loss and decreased overall mortality BACKGROUND Type 2 diabetes mellitus is increasingly common , primarily because of increases in the prevalence of a sedentary lifestyle and obesity . Whether type 2 diabetes can be prevented by interventions that affect the lifestyles of subjects at high risk for the disease is not known . METHODS We r and omly assigned 522 middle-aged , overweight subjects ( 172 men and 350 women ; mean age , 55 years ; mean body-mass index [ weight in kilograms divided by the square of the height in meters ] , 31 ) with impaired glucose tolerance to either the intervention group or the control group . Each subject in the intervention group received individualized counseling aim ed at reducing weight , total intake of fat , and intake of saturated fat and increasing intake of fiber and physical activity . An oral glucose-tolerance test was performed annually ; the diagnosis of diabetes was confirmed by a second test . The mean duration of follow-up was 3.2 years . RESULTS The mean ( + /-SD ) amount of weight lost between base line and the end of year 1 was 4.2+/-5.1 kg in the intervention group and 0.8+/-3.7 kg in the control group ; the net loss by the end of year 2 was 3.5+/-5.5 kg in the intervention group and 0.8+/-4.4 kg in the control group ( P<0.001 for both comparisons between the groups ) . The cumulative incidence of diabetes after four years was 11 percent ( 95 percent confidence interval , 6 to 15 percent ) in the intervention group and 23 percent ( 95 percent confidence interval , 17 to 29 percent ) in the control group . During the trial , the risk of diabetes was reduced by 58 percent ( P<0.001 ) in the intervention group . The reduction in the incidence of diabetes was directly associated with changes in lifestyle . CONCLUSIONS Type 2 diabetes can be prevented by changes in the lifestyles of high-risk subjects INTRODUCTION Endocrine disorders may adversely affect men 's sexual function . AIM To provide recommendations based on best evidence for diagnosis and treatment of endocrine-related male sexual dysfunctions .  METHODS The Endocrine Aspects of Male Sexual Dysfunctions Committee , including 11 members from eight countries and four continents , collaborated with the Endocrine subcommittee of the St and ards Committee of the International Society for Sexual Medicine . Medical literature was review ed in detail , followed by extensive internal committee discussion over 2 years , then public presentation and discussion with the other experts before finalizing the report . MAIN OUTCOME MEASURE Recommendations based on grading of evidence -base medical literature and interactive discussion . RESULTS From animal studies , it is derived that testosterone modulates mechanisms involved in erectile machinery , including expression of enzymes that both initiate and terminate erection . In addition , testosterone is essential for sexual motivation . Whether these findings could be extrapolated to human erections is unclear . Testosterone plays a broad role in men 's overall health . Recent studies have established strong associations between low testosterone and metabolic and cardiovascular imbalances . In some studies , low testosterone decreased longevity ; however , longitudinal studies do not support the predictive value of low testosterone for further cardiovascular events . The article proposes a st and ardized process for diagnosis and treatment of endocrine-related male sexual dysfunctions , updating the knowledge on testosterone and prostate safety . There is no compelling evidence that testosterone treatment causes prostate cancer or its progression in men without severe testosterone deficiency ( TD ) . The possible roles of prolactin and thyroid hormones are also examined . CONCLUSIONS Men with erectile dysfunction , hypoactive sexual desire and retarded ejaculation  , as well as those with visceral obesity and metabolic diseases , should be screened for TD and treated . Prospect i ve interventional studies are required before screening for TD in more conditions , including cardiovascular diseases , and considering correction as preventive medicine as much data suggests The effects of weight loss on erectile function and hormones have not been well studied . The aim of this study was to measure the degree to which sexual function and in particular erectile function and hormonal environment change after substantial weight loss , surgically and non-surgically induced in the morbidly obese male in a prospect i ve r and omized long-term controlled trial . Furthermore , how surgery makes a difference when treating morbidly obese men was envisaged in this context . We prospect ively studied 20 morbidly obese men for 24 months , divided into two groups : group  A  included 10 patients who underwent life style modifications ( exercise and diet ) for 4 months and subsequently gastric bypass , and another 10 patients in group B were kept on weekly follow-up . None of the men were taking phosphodiesterase type-5 inhibitors . All patients underwent International Index of Erectile Function (IIEF)-5 question naire , serum oestradiol , prolactin ( PRL ) , luteinizing ( LH ) and follicle-stimulating ( FSH ) hormones , free and total testosterone ( FT and TT ) at baseline ( time 0 ) , surgery - 4 months latter baseline ( time 1 ) and final evaluation - 24 months ( time 2 ) . From times 0 to 1 , group A presented a mean body mass index ( BMI ) reduction of 12.6 ( p < 0.0001 ) , whereas group B , 2.1 ( p > 0.05 ) . The BMI reductions between times 0 and 2 were 24.7 ( p < 0.0001 ) and 0.7 ( p > 0.05 ) for groups A and B respectively . BMI average between the two groups was similar at time 0 ( p = 0.2142 ) , and different at times 1 ( p = 0.0033 ) and 2 ( p < 0.0006 ) . Increase in IIEF-5 score ( p = 0.0469 ) , TT ( p = 0.0349 ) and FSH levels ( p = 0.0025 ) , and reduction in PRL level ( p < 0.0001 ) were observed in group A from times 0 to 2 and 1 to 2 . There were no changes from times 0 to 1 . Comparing groups A and B at time 2 , IIEF-5 , TT and FT increased significantly in group A ( p = 0.0224 , 0.0043 and 0.0149 respectively ) . Surgery-induced weight loss increased erectile function quality measured by IIEF-5 question naire , increased TT , FT and FSH and reduced PRL levels . The hormonal impact verified could justify the improvement in erectile function .  Lifestyle modifications impacted BMI without hormonal or sexual impact in morbidly obese . New studies are warranted in the field to support our data One of the main goals of weight reduction in morbidly obese subjects is its benefit on coronary heart disease ( CHD ) risk . A cross-sectional study was design ed to r and omly assign 79 morbidly obese subjects ( 27 men and 52 women ; age : 30 - 45 years ) either to a diet protocol ( 20 kcal per kg fat-free mass ( FFM ) ; 55 % carbohydrates , 30 % fat , and 15 % proteins ) or to malabsorptive surgery ( biliopancreatic diversion ) .  Fatness parameters , measured by dual-energy X-ray absorptiometry , lipid profile , insulin , leptin , sex steroid hormones and sex hormone-binding globulin ( SHBG ) levels were compared at baseline and 1 year after the beginning of the study . The data showed that plasma SHBG levels , but not testosterone levels , correlated negatively to fasting insulin levels and positively to HDL-cholesterol in both men and women . Total leptin levels were significantly lower ( P<0.0001 ) in post-BPD subjects of both sexes compared to dietary treated obese subjects . The logarithm of plasma leptin correlated significantly and positively with insulin but negatively with SHBG.A step-down regression analysis showed that FFM and SHBG , but not insulin levels , were the most powerful independent variables for predicting HDL-cholesterol levels in morbidly obese patients . The negative relationship between SHBG levels and CHD risk appears to be mediated by a concomitant variation in body fatness . Finally , in obese patients , SHBG levels seem to be an indicator of total adiposity rather than an index of an altered insulin/glucose homeostasis The few studies that have examined body composition after a carbohydrate-restricted diet have reported enhanced fat loss and preservation of lean body mass in obese individuals . The role of hormones in mediating this response is unclear . We examined the effects of a 6-week carbohydrate-restricted diet on total and regional body composition and the relationships with fasting hormone concentrations . Twelve healthy normal-weight men switched from their habitual diet ( 48 % carbohydrate ) to a carbohydrate-restricted diet ( 8 % carbohydrate ) for 6 weeks and 8 men served as controls , consuming their normal diet . Subjects were encouraged to consume adequate dietary energy to maintain body mass during the intervention . Total and regional body composition and fasting blood sample s were assessed at weeks 0 , 3 , and 6 of the experimental period . Fat mass was significantly ( P < or=.05 ) decreased ( -3.4 kg ) and lean body mass significantly increased ( + 1.1 kg ) at week 6 . There was a significant decrease in serum insulin ( -34 % ) , and an increase in total thyroxine ( T(4 ) ) ( + 11 % ) and the free T(4 ) index ( + 13 % ) . Approximately 70 % of the variability in fat loss on the carbohydrate-restricted diet was accounted for by the decrease in serum insulin concentrations . There were no significant changes in glucagon , total or free testosterone , sex hormone binding globulin ( SHBG ) , insulin-like growth factor-I ( IGF-I ) , cortisol , or triiodothyronine ( T(3 ) ) uptake , nor were there significant changes in body composition or hormones in the control group . Thus , we conclude that a carbohydrate-restricted diet result ed in a significant reduction in fat mass and a concomitant increase in lean body mass in normal-weight men , which may be partially mediated by the reduction in circulating insulin concentrations CONTEXT The cause of declining testosterone ( T )  in aging men and their relationships with risk factors are unclear . OBJECTIVE The objective of the study was to investigate the relationships between lifestyle and health with reproductive hormones in aging men . DESIGN This was a baseline cross-sectional survey on 3200 community-dwelling men aged 40 - 79 yr from a prospect i ve cohort study in eight European countries . RESULTS Four predictors were associated with distinct modes of altered function : 1 ) age : lower free T ( FT ; -3.12 pmol/liter.yr , P < 0.001 ) with raised LH , suggesting impaired testicular function ; 2 ) obesity : lower total T ( TT ; -2.32 nmol/liter ) and FT ( -17.60 pmol/liter ) for body mass index ( BMI ; > or = 25 to < 30 kg/m(2 ) ) and lower TT ( -5.09 nmol/liter ) and FT ( -53.72 pmol/liter ) for BMI 30 kg/m(2 ) or greater ( P < 0.001 - 0.01 , referent : BMI < 25 kg/m(2 ) ) with unchanged/decreased LH , indicating hypothalamus/pituitary dysfunction ; 3 ) comorbidity : lower TT ( -0.80 nmol/liter , P < 0.01 ) with unchanged LH in younger men but higher LH in older men ; and 4 ) smoking : higher SHBG ( 5.96 nmol/liter , P < 0.001 ) and LH ( 0.77 U/liter , P < 0.01 ) with increased TT ( 1.31 nmol/liter , P < 0.001 ) but not FT , compatible with a re setting of T-LH-negative feedback due to elevated SHBG . CONCLUSIONS Complex multiple alterations in the hypothalamic-pituitary-testicular axis function exist in aging men against a background of progressive age-related testicular impairment . These changes are differentially linked to specific risk factors . Some risk factors operate independently of but others interact with age , in contributing to the T decline . These potentially modifiable risk factors suggest possible preventative measures to maintain T during aging in men OBJECTIVE Isolated hypogonadotropic hypogonadism ( IHH ) is frequently observed in severely obese men , probably as a result of increased estradiol ( E(2 ) ) production and E(2)-mediated negative feedback on pituitary LH secretion . Aromatase inhibitors can reverse this process . This study evaluates whether letrozole once a week can normalize serum testosterone in severely obese men and maintain its long term effect . DESIGN Open , uncontrolled 6-month pilot study in 12 severely obese men ( body mass index>35.0 kg/m(2 ) ) with obesity-related IHH and free testosterone levels < 225 pmol/l , treated with  2.5 mg letrozole once a week for 6 months . RESULTS Six weeks of treatment reduced total E(2 ) from 123+/-11 to 58+/-7 pmol/l ( P<0.001 , mean+/-s.e.m . ) , and increased serum LH from 4.4+/-0.6 to 11.1+/-1.5 U/l ( P<0.001 ) . Total testosterone rose from 5.9+/-0.5 to 19.6+/-1.4 nmol/l ( P<0.001 ) , and free testosterone from 163+/-13 to 604+/-50 pmol/l ( P<0.001 ) . Total testosterone rose to within the normal range in all subjects , whereas free testosterone rose to supraphysiological levels in 7 out of 12 men . The testosterone and E(2 ) levels were stable throughout the week and during the 6-month treatment period . CONCLUSION Letrozole 2.5 mg once a week produced a sustained normalization of serum total testosterone in obese men with IHH . However , free testosterone frequently rose to supraphysiological levels . Therefore , a starting dose < 2.5 mg once a week is recommended INTRODUCTION Although penile blood flow ( PBF ) has been recommended as an additional diagnostic test in identifying erectile dysfunction ( ED ) patients at risk for latent cardiovascular disease , no study has ever assessed the possible association of PBF and the relational component of sexual function with incident major cardiovascular events ( MACE ) . AIM The aim of this study is to investigate whether severity of ED , PBF , and other factors related to a couple 's relationship predict incident MACE . METHODS A consecutive series of 1,687 patients was studied . Different clinical , biochemical , and instrumental  ( penile flow at color Doppler ultrasound )  parameters were evaluated . MAIN OUTCOME MEASURES Information on MACE was obtained through the City of Florence Registry Office . RESULTS During a mean follow-up of 4.3 + /- 2.6 years , 139 MACE , 15 of which were fatal , were observed . Cox regression analysis , after adjustment for age and Chronic Disease Score , showed that severe ED predicted MACE ( hazard ratio [ HR ] 1.75 ; 95 % confidence interval 1.10 - 2.78 ; P < 0.05 ) . In addition , lower PBF , evaluated both in flaccid ( before ) and dynamic ( after prostagl and in-E1 stimulation ) conditions , was associated with an increased risk of MACE ( HR = 2.67 [ 1.42 - 5.04 ] and 1.57 [ 1.01 - 2.47 ] , respectively , for flaccid [ < 13 cm/second ] and dynamic [ < 25 cm/second ] peak systolic velocity ; both P < 0.05 ) . Reported high sexual interest in the partner and low sexual interest in the patient proved to have a protective effect against MACE . CONCLUSIONS The investigation of male sexuality , and in particular PBF , and sexual desire , could provide insights not only into present cardiovascular status but also into prospect i ve risk BACKGROUND Type 2 diabetes affects approximately 8 percent of adults in the United States . Some risk factors -- elevated plasma glucose concentrations in the fasting state and after an oral glucose load , overweight , and a sedentary lifestyle -- are potentially reversible . We hypothesized that modifying these factors with a lifestyle-intervention program or the administration of metformin would prevent or delay the development of diabetes . METHODS We r and omly assigned 3234 nondiabetic persons with elevated fasting and post-load plasma glucose concentrations to placebo , metformin ( 850 mg twice daily ) , or a lifestyle-modification program  with the goals of at least a 7 percent weight loss and at least 150 minutes of physical activity per week . The mean age of the participants was 51 years , and the mean body-mass index ( the weight in kilograms divided by the square of the height in meters ) was 34.0 ; 68 percent were women , and 45 percent were members of minority groups . RESULTS The average follow-up was 2.8 years . The incidence of diabetes was 11.0 , 7.8 , and 4.8 cases per 100 person-years in the placebo , metformin , and lifestyle groups , respectively . The lifestyle intervention reduced the incidence by 58 percent ( 95 percent confidence interval , 48 to 66 percent ) and metformin by 31 percent ( 95 percent confidence interval , 17 to 43 percent ) , as compared with placebo ; the lifestyle intervention was significantly more effective than metformin . To prevent one case of diabetes during a period of three years , 6.9 persons would have to participate in the lifestyle-intervention program , and 13.9 would have to receive metformin . CONCLUSIONS Lifestyle changes and treatment with metformin both reduced the incidence of diabetes in persons at high risk . The lifestyle intervention was more effective than metformin BACKGROUND Weight loss is associated with short-term amelioration and prevention of metabolic and cardiovascular risk , but whether these benefits persist over time is unknown . METHODS The prospect i ve , controlled Swedish Obese Subjects Study involved obese subjects who underwent gastric surgery and contemporaneously matched , conventionally treated obese control subjects . We now report follow-up data for subjects ( mean age , 48 years ; mean body-mass index , 41 ) who had been enrolled for at least 2 years ( 4047 subjects ) or 10 years ( 1703 subjects ) before the analysis ( January 1 , 2004 ) . The follow-up rate for laboratory examinations was 86.6 percent at 2 years and 74.5 percent at 10 years . RESULTS After two years , the weight had increased by 0.1 percent in the control group and had decreased by 23.4 percent in the surgery group ( P<0.001 ) . After 10 years , the weight had increased by 1.6 percent and decreased by 16.1 percent , respectively ( P<0.001 ) . Energy intake was lower and the proportion of physically active subjects higher in the surgery group than in the control group throughout the observation period . Two- and 10-year rates of recovery from diabetes , hypertriglyceridemia , low levels of high-density lipoprotein cholesterol , hypertension , and hyperuricemia were more favorable in the surgery group than in the control group , whereas recovery from hypercholesterolemia did not differ between the groups . The surgery group had lower 2- and 10-year incidence rates of diabetes , hypertriglyceridemia , and hyperuricemia than the control group ; differences between the groups in the incidence of hypercholesterolemia and hypertension were undetectable . CONCLUSIONS As compared with conventional therapy , bariatric surgery appears to be a viable option for the treatment of severe obesity , result ing in long-term weight loss , improved lifestyle , and , except for hypercholesterolemia , amelioration in risk factors that were elevated at baseline PURPOSE The purpose of this study was to examine the physiological effects of a weight-loss dietary regimen with or without exercise . METHODS Thirty-five overweight men were matched and r and omly placed into either a control group ( C ; N = 6 ) or one of three dietary groups ; a diet-only group ( D ; N = 8) , a diet group that performed aerobic exercise three times per week ( DE ; N = 11 ) ; and a diet group that performed both aerobic and strength training three times per week ( DES ; N = 10 ) . RESULTS After 12 wk , D , DE , and DES demonstrated a similar and significant ( P < or = 0.05 ) reduction in body mass ( -9.64 , -8.99 , and -9.90 kg , respectively ) with fat mass comprising 69 , 78 , and 97 % of the total loss in body mass , respectively . The diet-only group also demonstrated a significant reduction in fat-free mass . Maximum strength , as determined by 1-RM testing in the bench press and squat exercise was significantly increased for DES in both the bench press ( + 19.6 % ) and squat exercise ( + 32.6 % ) . Absolute peak O2 consumption was significantly elevated in DE ( + 24.8 % ) and DES ( + 15.4 % ) . There were no differences in performance during a 30-s Wingate test for the DE and DES , whereas D demonstrated a significant decline in peak and mean power output . Resting metabolic rate ( RMR ) ( kcal x d(-1 ) ) was not significantly different for any of the groups except for the DE group . There were no significant changes in basal concentrations of serum glucose , BUN , cortisol , testosterone , and high density lipoprotein ( HDL ) cholesterol for any of the groups . Serum total cholesterol and low density lipoprotein ( LDL ) cholesterol were significantly decreased for all dietary groups . Serum triglycerides were significantly reduced for D and DES at week 6 and remained lower at week 12 for D , while triglycerides returned to baseline values for DES . CONCLUSIONS These data indicate that a weight-loss dietary regimen in conjunction with aerobic and resistance exercise prevents the normal decline in fat-free mass and muscular power and augments body composition , maximal strength , and maximum oxygen consumption compared with weight-loss induced by diet alone
target: And rogen rise is greater in those patients who lose more weight as well as in younger , non-diabetic subjects with a greater degree of obesity .
  Body weight loss is also associated with a decrease in estradiol and an increase in gonadotropins levels .
  These data show that weight loss is associated with an increase in both bound and unbound testosterone levels .
  The normalization of sex hormones induced by body weight loss is a possible mechanism contributing to the beneficial effects of surgery in morbid obesity
background: OBJECTIVE Few r and omized clinical studies have evaluated the impact of diet and physical activity on testosterone levels in obese men with conflicting results .
  Conversely , studies on bariatric surgery in men generally have shown an increase in testosterone levels .
  The aim of this study is to perform a systematic review and meta- analysis of available trials on the effect of body weight loss on sex hormones levels .