Via practica 4/2024
Obesity from andrologist point of view
Obesity and/or multiple obesity-related diseases can affect sexual function and urological diseases in both men and women. Obesity in men is associated with symptoms of hypogonadism, erectile dysfunction, benign prostatic hyperplasia, prostate cancer, micturition difficulties, urinary stones and also has a negative impact on fertility. Adipose tissue to an increased extent produces inflammatory factors, especially adipokines (leptin, resistin, adiponectin, visfaltin and others) and cytokines – tumor necrosis factor α (TNFα) and interleukin 6 and 1 (IL6, IL1). Of these, leptin in particular is involved in the aromatization of sex steroids, which changes the balance of the endocrine state. Neuroendocrine regulation of both sex hormones – testosterone and estradiol in the CNS, according to the latest findings, is subject to both genomic and non-genomic regulation and, in men with a certain phenotype, to a possible connection to alternative signaling pathways leading to carcinogenesis. It has been proven that the ratio of androgens to estrogens is of much greater clinical significance for the health of both men and women than the concentration of testosterone or estradiol alone. Examination of hypogonadism is recommended in men with obesity or type 2 diabetes, regardless of age and manifestation of sexual dysfunctions. The TRAVERSE study proved that testosterone supplementation in confirmed hypogonadism is effective, safe and has demonstrable cardioprotective effects on men’s health. Obesity in men causes activation of inflammatory cascades leading to reduced production and availability of NO, important for erectile function. The importance of the NO/cGMP/cAMP cascade has been demonstrated at the central level (CNS) in connection with cognitive functions, neuroregeneration of the CNS and the prevention of dementia. According to the results of the latest research, insulin is a key scientific finding for the association of obesity with aggressive prostate cancer.
Keywords: obesity, testosterone, hypogonadism, erectile dysfunction, infertility, CNS neuroregeneration, insulin
