LAUSR

Abstract Background: Weight loss in obese subjects is notoriously difficult to achieve through lifestyle interventions, and even harder to maintain long-term. Testosterone therapy has shown promising results in long-term but not short-term studies. Material and Methods: In an observational registry study of 805 men with hypogonadism in a urological office, 462 (57.4%) were obese. 273 received TTh with TU 1000 mg/12 weeks (T-group) while 189 opted against TTh and served as controls (CTRL). Measurements were performed 1-4 times a year. 10-year data are reported. Changes over time between groups were compared by mixed effects model for repeated measures with random effect for intercept and fixed effects for time, group and their interaction, and adjusted for age, weight, waist circumference, fasting glucose, blood pressure and lipids to account for baseline differences between groups. Results: Baseline age: 59.8±6.1 (T-group), 63.5±5 years (CTRL). Mean (median) follow-up: 8 (9) years (T-group) and 7.5 (8) years (CTRL). Total observation time: 3588 patient-years. Weight progressively decreased by 22.9±0.3 kg (p<0.0001) (T-group) and increased by 3.2±0.5 kg (p<0.0001) in CTRL, estimated adjusted difference between groups: 26.1 kg (p<0.0001). Waist circumference declined by 12.5±0.2 cm (p<0.0001) (T-group) and increased by 4.6±0.4 cm (p<0.0001) in CTRL, difference between groups: 17.1 cm (p<0.0001). BMI decreased by 7.3±0.1 kg/m2 (p<0.0001) (T-group) and increased by 0.9±0.2 kg/m2 (p<0.0001) in CTRL, difference between groups: 8.2 kg/m2 (p<0.0001). Per cent weight loss was 20.3±0.3% (p<0.0001) in the T-group, per cent weight gain 3.9±0.4% (p<0.0001) in CTRL, difference between groups: 24.3% (p<0.0001). Waist-to-height ratio decreased by 0.07±0.001 (p<0.0001) (T-group) and increased by 0.03±0.002 (p<0.05) in CTRL, difference between groups: 0.1 (p<0.0001). Adverse events: During the entire observation time, there were 12 deaths (4.4%) in the T-group. In CTRL, there were 57 deaths (30.2%), 47 MIs (24.9%) and 44 strokes (23.3%). Medication adherence in the T-group was 100 per cent as all TU-injections were performed in the office and documented. Conclusion: Long-term TTh in men with hypogonadism and obesity resulted in profound and sustained improvements in anthropometric parameters, as well as reduction of mortality and major adverse cardiovascular events. As recommended by the AACE/ACE 2016 obesity guidelines, testosterone should be measured in obese men and testosterone treatment offered if indicated.