Correlation between weight loss and testosterone restoration after sleeve gastrectomy in patients with biochemical male obesity-associated secondary hypogonadism

Male obesity-associated secondary hypogonadism (MOSH) affects metabolic and reproductive health. We evaluated the efficacy of laparoscopic sleeve gastrectomy (LSG) on the remission of MOSH and testosterone concentrations and examined the association between weight loss and changes in testosterone concentrations. In this retrospective study, 304 male patients with obesity who underwent LSG at the Center for Obesity and Hernia Surgery, Huashan Hospital, Fudan University (Shanghai, China) between October 2022 and December 2024 were screened. Metabolic and hormonal parameters were evaluated at baseline and at 6 months, 12 months, and 24 months post-LSG. The primary outcome was the remission of MOSH. Secondary outcomes were changes in total testosterone concentrations and free testosterone concentrations, and their correlations with the percentage of total weight loss (TWL%). Among 304 screened patients, 212 were diagnosed with MOSH and 186 were included (mean ± standard error s.e.; age: 33.1 ± 0.6 years; body mass index: 43.0 ± 0.5 kg m −2 ). MOSH remission rates at 6 months, 12 months, and 24 months post-LSG were 81.4%, 79.7%, and 89.5%, respectively, accompanied by a substantial increase in total testosterone and free testosterone concentrations. TWL% (mean ± s.e.) reached 28.2% ± 0.9%, 34.4% ± 1.2%, and 32.3% ± 2.2% at the respective time points. Linear mixed models showed significant positive correlations between TWL% and total testosterone and free testosterone concentrations after surgery (both P < 0.001). LSG induced the remission of MOSH and restored testosterone concentrations. Sustained weight loss is pivotal in driving endocrine recovery, suggesting that LSG is effective for managing MOSH.