An important concern related to otherwise desirable weight loss induced by hypocaloric dieting, especially in older obese men who are already at risk of sarcopenia, is the concomitant loss of muscle mass causing altered function of muscle and physical functional decline.52,54 Although this accelerated loss of muscle mass can be attenuated by exercise,57 adherence to an exercise program is often difficult to achieve. Indeed, although controversial, measurement of free testosterone levels may provide a more accurate assessment of androgen status than the (usually preferred) measurement of total testosterone in situations where SHBG levels are outside the reference range.24 However, reference ranges for free testosterone levels are not well established, especially in older men whose SHBG increases with age. In summary, observational studies consistently show a strong association of obesity with low circulating testosterone levels in men. For example, in a cross-sectional study, while Japanese and Hong Kong Asian men had higher unadjusted testosterone levels than Swedish and US men, these differences did not persist when adjusted for BMI.21 Similarly, in a multi-ethnic Malaysian population, the lower (11%) prevalence of low testosterone in Chinese compared Malay and Indian men (21%) was due to a higher burden of obesity and the metabolic syndrome in the latter.22 Both total testosterone (5.9 nmol l−1) and free testosterone (54 pmol l−1) levels were lower in obese compared to lean men, with lesser but still significant reduction in overweight men (total T 2.3 nmol l−1, free T 18 pmol l−1)16. Low testosterone levels are frequently encountered in obese men who do not otherwise have a recognizable hypothalamic-pituitary-testicular (HPT) axis pathology. The intersection of obesity, hormones and fertility underscores the need for a more nuanced understanding of women’s health.
These findings are supported by several other studies in which testosterone therapy resulted in improved motivation, vigor, energy, and reduces fatigue concomitant with significant reduction in waist circumference and improvement in quality of life 44,47,48,57▪,95. Testosterone treatment of 1053 hypogonadal men produced increased quality of life with reduced fatigue, increased libido and erectile function and reduced waist circumference . Yu and Traish suggested that testosterone deficiency contributes to fatigue via alterations of mitochondrial function and energy production and utilization. Testosterone treatment results in improved insulin sensitivity, lipid oxidation and reduction in fat mass with concomitant gain in fat free mass.
This structure releases chemicals that make your sex organs produce testosterone. Imagine having three dominoes that must fall in order to release testosterone. According to the Centers for Disease Control and Prevention (CDC), more than 2 in 5 people in the United States live with obesity. In the adipose tissue, which stores fat cells, it breaks down fat. In males, it drives the development of sexual features and muscle mass during puberty, according to Cleveland Clinic.
With increasing modernization and urbanization of Asia, much of the future focus of the obesity epidemic will be in the Asian region.
Both aerobic (running) and anaerobic (weight lifting) workouts have benefits. Lower testosterone can also reduce sex drive and cause erectile dysfunction in men, according to Cleveland Clinic. A decrease in testosterone also influences sleep and sexual desire. As muscle shrinks, people with low testosterone might lose strength and feel weaker. Metabolic syndrome includes obesity, heart and blood vessel disease, and hypertension (high blood pressure). A negative feedback loop controls estradiol and testosterone.
Given these important functions of this hormone, it is concerning that testosterone levels in men around the world are in decline1. While HPT axis reactivation is achievable with weight loss, the degree of weight loss required to achieve this may be difficult to achieve and to maintain, with usual lifestyle changes for many obese men. However, because of insufficient evidence regarding its risk-benefit ratio, testosterone treatment should not be used for the sole purpose of weight loss. In comparison to lifestyle, surgical intervention resulted in loss of weight of 28%–44% and increase of testosterone from 7.8 to 12.5 nmol l−1. Overall, diet led to modest weight loss (6%–17%) with modest increases in testosterone (2.9–5.1 nmol l−1). Table 2 lists 15 published trials that have assessed the effects of weight loss interventions on testosterone.62,63,64,65,66,67,68,69,70,71,72,73,74,75 The majority of the trials was single-arm cohort studies and included small numbers of subjects. Whether testosterone treatment will attenuate the catabolic effects of diet restriction on loss of muscle mass and function, requires further study.
Now, thanks to Hone’s at-home hormone test, testing your hormone levels has never been easier or more discreet. Too much estrogen in a male body is not a good thing; it can cause erectile dysfunction, or low libido." Accompanying the weight gain is muscle loss, and the inability to perform workouts to the same levels as before, but also seeing fewer results from the same workouts. On the other hand, free testosterone is floating around your body, ready to be recruited by your cells. Your body then metabolizes your total testosterone into other substances to keep you functioning optimally.
In obesity induced adipocyte dysfunction, there is increased leptin release from adipocytes, which, in turn, causes a central leptin resistance at the hypothalamo-pituitary level. Testosterone and its aromatisation product, oestradiol, activate androgen receptors (AR) and estrogen receptors (ERα and ERβ) within the visceral adipose tissue, with a resultant decrease in the release of adipokines (leptin, tumor necrosis factor alpha TNF-α, interleukin-6 IL-6, osteoprotegerin, monocyte chemoattractant protein-1α) and increase in the release of adiponectin and visfatin. The resultant reduction in circulating testosterone level leads to further adipocyte hypertrophy and further worsening of testosterone deficiency. The resultant increase in oestrogen, leptin, insulin and inflammatory cytokines result in hypothalamo–pituitary–testicular (HPT) axis suppression.28
Similarly, even mildly high levels of prolactin imbalance can affect the hormonal signals that are required for ovulation. Bakshi further added that over time, higher insulin can also badly affect the egg quality and overall ovarian reserve. Insulin resistance, in particular, can interfere with ovulation and also lead to higher androgen levels, which over time may affect ovarian reserve. Dr Sugata Mishra, Fertility Specialist, Birla Fertility & IVF, Kolkata, said, "When we talk about obesity and fertility, BMI doesn’t always give us the complete picture. This broader lens helps identify "metabolically unhealthy" individuals who may otherwise be overlooked. This makes early intervention crucial—not just for weight management, but for preserving reproductive potential.

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