High Prevalence of Subnormal Testosterone in Obese Adolescent Males: Reversal with Bariatric Surgery

2022 ◽  
Author(s):  
Sandeep Dhindsa ◽  
Husam Ghanim ◽  
Todd Jenkins ◽  
Thomas H. Inge ◽  
Carroll M. Harmon ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Free Testosterone ◽  
Adolescent Males ◽  
Total Testosterone ◽  
Longitudinal Assessment ◽  
Obese Adolescent ◽  
Study Participants ◽  
Age Range ◽  
Design And Methods

Objective: Obesity in adolescent males is associated with lowering of total and free testosterone concentrations. Weight loss may increase testosterone concentrations. Design and Methods: We evaluated changes in sex hormones following bariatric surgery in 34 males (age range 14.6 – 19.8 years) with obesity. These participants were part of prospective multicenter study, Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS). Participants were followed for five years after surgery. Total testosterone, total estradiol, LH, FSH, SHBG, CRP, insulin and glucose were measured at baseline, six months and annually thereafter. Free testosterone, free estradiol and HOMA2-IR were calculated. Results: Study participants lost one-third of their body weight after bariatric surgery, with maximum weight loss achieved at 24 months for most participants. Free testosterone increased from 0.17 nmol/L(95% CI: 0.13, 0.20) at baseline to 0.34 (95% CI: 0.30, 0.38) at two years and 0.27(95% CI: 0.23, 0.32) nmol/L at five years (p<0.001 for both) respectively. Total testosterone increased from 6.7 nmol/L (95% CI: 4.7, 8.8) at baseline to 17.6(95% CI: 15.3, 19.9) and 13.8(95% CI: 11.0, 16.5) nmol/L at two and five years(p<0.001). Prior to surgery 73% of the participants had subnormal free testosterone(<0.23 nmol/L). After two years and five years, only 20% and 33%, respectively, had subnormal free testosterone concentrations. Weight regain was related to a fall in free testosterone concentrations. Conclusions: Bariatric surgery led to a robust increase in testosterone concentrations in adolescent males with severe obesity. Participants who regained weight had a decline in their testosterone concentrations.

scholarly journals Men with Latent Autoimmune Diabetes and Type 2 Diabetes May Have Different Change Patterns in Free Testosterone

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Bo Ding ◽  
Feng-fei Li ◽  
Xiao-fang Zhai ◽  
Lei Ye ◽  
Yun Hu ◽  
...  
Keyword(s):  
Autoimmune Diabetes ◽  
Free Testosterone ◽  
Significant Negative Correlation ◽  
Total Testosterone ◽  
Model Assessment ◽  
Latent Autoimmune Diabetes ◽  
Male Patients ◽  
Design And Methods

Objective. Type 2 diabetic (T2D) male patients with low total testosterone (TT) levels are at an increasing risk of all-cause mortality. However, the levels of TT in male patients with latent autoimmune diabetes in adults (LADA) remain largely unknown. Research Design and Methods. This was a single-center, open, observational study. The inclusion criteria were male patients who were diagnosed with LADA, and sex, body mass index, C-peptide, and glycated hemoglobin (HbA1c) levels matched with those of T2D patients. Islet function/sensitivity and sex hormone concentrations were determined at baseline and 1-year follow-up. The primary endpoint was the changes in androgen levels from baseline to 1-year follow-up in patients with LADA. Results. Our data showed that TT and Bio-T levels remained unchanged, while FT levels significantly decreased from baseline to 1-year follow-up in patients with T2D. However, TT, Bio-T, and FT concentrations dramatically increased in the LADA group from baseline to 1-year follow-up. Furthermore, a Spearman analysis showed that changes of TT, FT, and Bio-T levels from baseline to endpoint were significantly negatively correlated with Δ homeostasis model assessment-2 IR (ΔHOMA2-IR), respectively. Conclusions. The FT change patterns in patients with LADA may differ from those in patients with T2D. Our data also indicated the significant negative correlation between insulin sensitivity and changes of TT, FT, and Bio-T levels along with the diabetic duration in patients with T2D and LADA.

scholarly journals Minimum Threshold of Bariatric Surgical Weight Loss for Initial Diabetes Remission

2021 ◽  
Author(s):  
Douglas Barthold ◽  
Elizabeth Brouwer ◽  
Lee J. Barton ◽  
David E. Arterburn ◽  
Anirban Basu ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Proportional Hazards ◽  
Reference Group ◽  
Diabetes Remission ◽  
Cox Proportional Hazards ◽  
Proportional Hazards Models ◽  
Cox Proportional Hazards Models ◽  
Design And Methods ◽  
Time Varying Covariates

<b>Objective:</b> There are few studies testing the amount of weight loss necessary to achieve initial remission of type 2 diabetes (T2DM) following bariatric surgery and no published studies using weight loss to predict initial T2DM remission in sleeve gastrectomy (SG) patients. <p><b>Research Design and Methods:</b> Cox proportional hazards models examined the relationship between initial T2DM remission and percent total weight loss (%TWL) after bariatric surgery. Categories of %TWL were included in the model as time-varying covariates. </p> <p><b>Results:</b> Patients (N=5,928) were 73% female, 49.8<u>+</u>10.3 years old, had BMI of 43.8<u>+</u>6.92 kg/m<sup>2</sup>, and 57% had Roux-en-Y gastric bypass (RYGB). Over an average follow-up of 5.9 years, 71% of patients experienced initial remission of their T2DM (mean time to remission 1.0 year). Using 0-5% TWL as the reference group in Cox proportional hazards models, patients were more likely to remit with each 5% increase in TWL until 20% TWL (range from HR=1.97 to 2.92). When categories above >25% TWL were examined, all had a likelihood of initial remission similar to 20-25% TWL. Patients who achieved >20% TWL were more likely to achieve initial T2DM remission than patients with 0-5% TWL, even if they were using insulin at the time of surgery.</p> <p><b>Conclusions: </b>Weight loss after bariatric surgery is strongly associated with initial T2DM remission; however, above a threshold of 20% TWL, rates of initial T2DM remission did not increase substantially. Achieving this threshold is also associated with initial remission even in patients who traditionally experience lower rates of remission, such as patients taking insulin.</p>

scholarly journals Changes in Testosterone Levels and Sex Hormone-Binding Globulin Levels in Extremely Obese Men after Bariatric Surgery

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Patchaya Boonchaya-anant ◽  
Nitchakarn Laichuthai ◽  
Preaw Suwannasrisuk ◽  
Natnicha Houngngam ◽  
Suthep Udomsawaengsup ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Hypogonadotropic Hypogonadism ◽  
Free Testosterone ◽  
Serum Levels ◽  
Sex Hormone Binding Globulin ◽  
Total Testosterone ◽  
Morbidly Obese ◽  
The Mean ◽  
A Prospective Study ◽  
Estradiol Levels

Objective.Obesity is a risk factor for hypogonadotropic hypogonadism in men. Weight loss has been shown to improve hypogonadism in obese men. This study evaluated the early changes in sex hormones profile after bariatric surgery.Methods.This is a prospective study including 29 morbidly obese men. Main outcomes were changes in serum levels of total testosterone (TT), free testosterone (cFT), SHBG, estradiol, adiponectin, and leptin at 1 and 6 months after surgery.Results.The mean age of patients was 31 ± 8 years and the mean BMI was 56.8 ± 11.7 kg/m2. Fifteen patients underwent Roux-en-Y gastric bypass and 14 patients underwent sleeve gastrectomy. At baseline, 22 patients (75.9%) had either low TT levels (<10.4 nmol/L) or low cFT levels (<225 pmol/L). Total testosterone and SHBG levels increased significantly at 1 month after surgery (p≤0.001). At 6 months after surgery, TT and cFT increased significantly (p≤0.001) and 22 patients (75.9%) had normalized TT and cFT levels. There were no changes in estradiol levels at either 1 month or 6 months after surgery.Conclusions. Increases in TT and SHBG levels occurred early at 1 month after bariatric surgery while improvements in cFT levels were observed at 6 months after bariatric surgery.

scholarly journals Good Glycemic Outcomes Following Bariatric Surgery Among Patients With Type 2 Diabetes, Obesity, and Low-Titer GAD Antibodies

2020 ◽  
Author(s):  
Ruveena Kaur ◽  
David Kim ◽  
Richard Cutfield ◽  
Michael Booth ◽  
Lindsay Plank ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Bariatric Surgery ◽  
Weight Loss ◽  
Diabetes Remission ◽  
Acid Decarboxylase ◽  
Gad Antibodies ◽  
C Peptide ◽  
Glycemic Outcomes ◽  
Design And Methods

<i>Objective</i>: To evaluate diabetes remission after bariatric surgery by presence of glutamic acid decarboxylase (GAD) antibody among those with obesity and Type 2 diabetes (T2D). <p> </p><i>Research Design and Methods</i>: Screening GAD was performed in 221 patients with T2D and obesity referred for bariatric surgery. 9/16 patients with GAD and 112/205 without GAD proceeded with surgery. Diabetes remission and weight loss was compared by GAD presence. <p> </p><i>Results</i>: GAD titres were 16-91 IU/mL in the first group. Both groups were similar in age, BMI, diabetes duration, insulin treated proportion, HbA1c and C-peptide (1354 ± 548 vs 1358 ± 487pmol/L). At 1 and 5 years post-operatively, both groups achieved similar BMI reduction and diabetes remission (67% vs 73%, p=0.71, and 56% vs 57%, p=1.0). <p><i> </i></p><i>Conclusion</i>: Low-titre GAD in patients with T2D and retained C-peptide, should not be a deterrent for bariatric surgery when the principal aim is diabetes remission.

scholarly journals Long-term follow-up of gonadal dysfunction in morbidly obese adolescent boys after bariatric surgery

2018 ◽  
Vol 0 (0) ◽  
Author(s):  
Vivian L. Chin ◽  
Kristen M. Willliams ◽  
Tegan Donnelley ◽  
Marisa Censani ◽  
Rushika Conroy ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Bariatric Surgery ◽  
Total Testosterone ◽  
Morbidly Obese ◽  
Fasting Insulin ◽  
Adolescent Boys ◽  
Obese Adolescent ◽  
Gonadal Dysfunction ◽  
T1 And T2

Abstract Background Elevated body mass index (BMI) is associated with hypogonadism in men but this is not well described in adolescents. The aim is to evaluate gonadal dysfunction and the effects of weight loss after gastric banding in obese adolescent boys. Methods Thirty-seven of 54 boys (age 16.2±1.2 years, mean BMI 48.2 kg/m2) enrolled at the Center for Adolescent Bariatric Surgery at Columbia University Medical Center had low total testosterone for Tanner 5 <350 ng/dL. Sixteen had long-term hormonal data for analysis at baseline (T0), 1 year (T1) and 2 years (T2) post-surgery. T-tests, chi-squared (χ2) tests, correlation and linear mixed models were performed. Results At T0, the hypogonadal group had higher systolic blood pressure (SBP) (75th vs. 57th percentile, p=0.02), fasting insulin (19 vs. 9 μIU/mL, p=0.0008) and homeostatic index of insulin resistance (HOMA-IR) (4.2 vs. 1.9, p=0.009) compared to control group. Total testosterone was negatively correlated with fasting insulin and HOMA-IR. In the long-term analysis, BMI, weight, waist circumference (WC), and % excess weight decreased at T1 and T2 compared to T0. Mean total testosterone at T0, T1 and T2 were 268, 304 and 368 ng/dL, respectively (p=0.07). There was a statistically significant negative correlation between BMI and testosterone after 2 years (r=−0.81, p=0.003). Conclusions Low testosterone levels but unaltered gonadotropins are common in this group and associated with insulin resistance. While a significant increase in testosterone was not found over time, the negative relationship between BMI and testosterone persisted, suggesting there may be an optimal threshold for testosterone production with respect to BMI. Long-term studies are needed.

Abstract MP86: Hemodynamic and Metabolomic Change From Lifestyle Driven Weight Loss in Obese Adolescents

Circulation ◽  
2016 ◽  
Vol 133 (suppl_1) ◽  
Author(s):  
Justin P Zachariah ◽  
Jane W Newburger ◽  
Gary F Mitchell
Keyword(s):  
Blood Pressure ◽  
Bariatric Surgery ◽  
Heart Rate ◽  
Weight Loss ◽  
Augmentation Index ◽  
Free Play ◽  
Metabolomic Analysis ◽  
Entry And Exit ◽  
Obese Adolescent ◽  
Obese Adolescents

Background: While bariatric surgery is known to induce hemodynamic and metabolic pathway alterations, lifestyle-driven weight loss in obese adolescents are not well characterized with respect to hemodynamic and metabolomic effects. We studied aortic function and urine metabolomics changes in obese adolescent volunteers attending weight loss summer camps. Methods: Adolescents (n=45, 71% girls, mean age 15±1 year) attending long-standing weight loss camps over 3 summers volunteered to have weight, long term diet and activity history, and vascular tonometry after overnight fast at camp entry and exit. A subset (n=32) also gave urine entry and exit urine samples for metabolomic analysis (Metabolon, Durham NC). Camp administrators followed pre-existing protocols encouraging campers toward 5 hours or more of structured activity and free play as well as nutritionist-designed meal plan restricted to age-sex specific calorie goals. Paired students T-tests were used to assess changes in anthropometrics and hemodynamics. Osmolality-adjusted metabolomic changes were analyzed using principal components analysis; paired T-test with multiple comparison adjustment by Storey-Tibshirani false discovery rate thresholding; and Random Forest decision tree ensembles with selection of the top 30 biochemicals in variable importance gleaned from the Mean Decrease Accuracy metric, which randomly permutes a given chemical and reassesses predictive accuracy throughout the tree ensembles, and then grouped into pathway categories. Results: Median camp length was 6 weeks (25%,75% IQR 5,7). Campers on average lost body 11±4% of body weight (99±20 to 88±17 kilograms, p<0.0001). Supine systolic blood pressure declined from 115±11 to 111±12 mmHg (p<0.01), diastolic blood pressure from 57±8 to 52±7 mmHg (p<0.0001), and heart rate from 73±10 to 62±11 beats per minute (p<0.0001). Carotid femoral pulse wave velocity decreased from 5.4±0.7 to 5.1±0.6 meters per second (p<0.0001). This change in arterial stiffness was not dependent on changes in heart rate nor distending pressure. Augmentation index did not significantly change from 17±11% to 16±9% (p=0.5). On urine metabolomic analysis, altered biochemical pathways included lipid metabolism, bile acids, and carbohydrate excretion. Conclusions: Diet and activity driven weight loss in excess weight adolescents is associated with salutary hemodynamic improvement and specific metabolic alterations, paralleling findings after bariatric surgery. More investigation into the mechanisms of lifestyle driven weight loss is warranted.

scholarly journals Good Glycemic Outcomes Following Bariatric Surgery Among Patients With Type 2 Diabetes, Obesity, and Low-Titer GAD Antibodies

2020 ◽  
Author(s):  
Ruveena Kaur ◽  
David Kim ◽  
Richard Cutfield ◽  
Michael Booth ◽  
Lindsay Plank ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Bariatric Surgery ◽  
Weight Loss ◽  
Diabetes Remission ◽  
Acid Decarboxylase ◽  
Gad Antibodies ◽  
C Peptide ◽  
Glycemic Outcomes ◽  
Design And Methods

<i>Objective</i>: To evaluate diabetes remission after bariatric surgery by presence of glutamic acid decarboxylase (GAD) antibody among those with obesity and Type 2 diabetes (T2D). <p> </p><i>Research Design and Methods</i>: Screening GAD was performed in 221 patients with T2D and obesity referred for bariatric surgery. 9/16 patients with GAD and 112/205 without GAD proceeded with surgery. Diabetes remission and weight loss was compared by GAD presence. <p> </p><i>Results</i>: GAD titres were 16-91 IU/mL in the first group. Both groups were similar in age, BMI, diabetes duration, insulin treated proportion, HbA1c and C-peptide (1354 ± 548 vs 1358 ± 487pmol/L). At 1 and 5 years post-operatively, both groups achieved similar BMI reduction and diabetes remission (67% vs 73%, p=0.71, and 56% vs 57%, p=1.0). <p><i> </i></p><i>Conclusion</i>: Low-titre GAD in patients with T2D and retained C-peptide, should not be a deterrent for bariatric surgery when the principal aim is diabetes remission.

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