Right now we have a ton of evidence that if overweight/obese men lose weight their total and free testosterone goes up, but very modestly (recent evidence summarized below). In my opinion, it is time to stop beating that horse and run some kind of efficacy trial where you keep diet the same between groups and have a weight loss arm and an arm where you throw the kitchen sink at the problem – increased sleep, early morning light exposure, micronutrient supplementation, appropriate resistance training, stress management, and nutrients needed for estrogen detoxification and GI clearance. This study would essentially investigate if throwing the “functional medicine” kitchen sink at the problem out performs something that we know already works.

Are these lifestyle and nutritional strategies synergistic and additive? Anecdotally, I would say HELL YES, but my opinion isn’t going to change public policy, thus it would be great to see published research with individual data points.

I also probably shouldn’t be the one to run this experiment because of my biases, but in the future maybe I can run some kind of wait-listed Costa Rica efficacy experiment where men come down here for 12 weeks and we see what happens.

The idea is floating around up there, now we just have to build the location. Good thing we broke ground yesterday.

But, don’t wait for the fancy retreat center to be built, if you are an overweight/obese man run your own n of 1 experiment with all the things right now. The worst outcome is that you maintain consistent weight loss and a modest elevation in testosterone. Also, don’t get your panties in a bunch about what diet or exercise program is best, because the best one is the one you can stick to…forever.

And here is some new science on weight loss and testosterone concentrations.

“These data confirm prior reports in overweight and obese men that weight loss increases testosterone and SHBG and improves overall sexual function. Weight loss did not alter erectile function, sexual desire or lower urinary tract symptoms for all participants combined.”

-Moran et al. 2016

This study was just published out of Australia and was a long prospective RCT in overweight/obese men with varying ns based on time point. The study compared a higher protein/lower carb diet with a lower protein/higher carb diet while fat content was held the same between groups. There was an initial 12 weeks of weight loss (n=110) and another 40 weeks of maintenance (n fell to 68). There was no exercise arm, just diet, and adherence was assessed with dietary recalls every two weeks.

Over the entire year, these subjects lost about 23 pounds (17.6 pounds of that being fat) with no significant differences between intervention groups. Total testosterone increased by about 58 ng/dL and SHBG dropped 4.6 nmol/L over the course of the entire study, thus raising free testosterone by a little over 13%. There were no significant differences between the two diets in hormonal changes.

This is not groundbreaking by any means and the results are somewhat modest

“It is unclear whether these modest changes in acute weight loss are sufficient to result in substantive effects at the tissue level.”

These results do however highlight that the mechanism of weight loss is probably not a major factor in the elevation in male hormones from weight loss and there seems to be a dose effect.

Most TRT docs would rightfully scoff at a years’ worth of effort for a 58 point bump in total testosterone. It’s probably why they and the men in question are quick with the needle. The subjects in the above study are your prototypical low T patients with testosterone levels in the mid to 300s. But, could these men see even more drastic improvements if you looked at more aspects of their life their just their waist circumference?

To quote a fantastic a very robust meta-analysis by Corona et al

“Male hypogonadism can be considered as one of the many adverse consequences of overweight and obesity. Body weight loss and lifestyle interventions should be the first approach offered to obese hypogonadal men. However, their effect on testosterone levels is modest.”

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