Journal of endocrinological investigation · 2026
The impact of type 2 diabetes on male obesity-associated secondary hypogonadism patients undergoing sleeve gastrectomy.
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Zhao Yian, Cao Chong, Hua Rong, Tan Xiaozhuo, Chu Yuxiao, He Mengcheng, Yao Xinyu, Xu Bo, Shen Qiwei, Fu Xiaojian, Yao Qiyuan, Shao Yikai
Аннотация
PURPOSE: Type 2 diabetes mellitus (T2DM) frequently coexists with male obesity-associated secondary hypogonadism (MOSH). This study aims to determine the impacts of T2DM on both baseline features and postoperative outcomes after metabolic bariatric surgery in MOSH patients.
METHODS: In this retrospective, two-arm cohort study, patients with MOSH undergoing laparoscopic sleeve gastrectomy (LSG) between January 2021 and June 2025 were stratified by T2DM status and matched 1:1 by age, yielding 174 patients per group. Weight loss, metabolic parameters and sex hormones were assessed at baseline and 12 months post-LSG.
RESULTS: Preoperatively, the T2DM group exhibited significantly lower levels of total testosterone (TT) (6.19 vs. 7.13 nmol/L, P < 0.001), free testosterone (FT) (0.16 vs. 0.18 nmol/L, P < 0.05) and bioavailable testosterone (BT) (3.88 vs. 4.27 nmol/L, P < 0.01). Postoperatively, two groups achieved similar weight loss and MOSH remission rates. While TT/FT rose markedly and to similar levels in both groups at 12 months post-LSG (TT: 16.67 vs. 17.09 nmol/L, P = 0.251; FT: 0.34 vs. 0.36 nmol/L, P = 0.195), the T2DM group exhibited persistently lower testosterone bioavailability (BT: 8.28 vs. 8.91 nmol/L, P = 0.013).
CONCLUSION: T2DM exacerbates the androgen deficiency in MOSH. Although LSG produces substantial and comparable weight loss, glycemic control, and rises in testosterone across groups, patients with T2DM show incomplete recovery of testosterone bioavailability post-LSG, underscoring the need for targeted postoperative monitoring of androgen bioavailability in this population.
METHODS: In this retrospective, two-arm cohort study, patients with MOSH undergoing laparoscopic sleeve gastrectomy (LSG) between January 2021 and June 2025 were stratified by T2DM status and matched 1:1 by age, yielding 174 patients per group. Weight loss, metabolic parameters and sex hormones were assessed at baseline and 12 months post-LSG.
RESULTS: Preoperatively, the T2DM group exhibited significantly lower levels of total testosterone (TT) (6.19 vs. 7.13 nmol/L, P < 0.001), free testosterone (FT) (0.16 vs. 0.18 nmol/L, P < 0.05) and bioavailable testosterone (BT) (3.88 vs. 4.27 nmol/L, P < 0.01). Postoperatively, two groups achieved similar weight loss and MOSH remission rates. While TT/FT rose markedly and to similar levels in both groups at 12 months post-LSG (TT: 16.67 vs. 17.09 nmol/L, P = 0.251; FT: 0.34 vs. 0.36 nmol/L, P = 0.195), the T2DM group exhibited persistently lower testosterone bioavailability (BT: 8.28 vs. 8.91 nmol/L, P = 0.013).
CONCLUSION: T2DM exacerbates the androgen deficiency in MOSH. Although LSG produces substantial and comparable weight loss, glycemic control, and rises in testosterone across groups, patients with T2DM show incomplete recovery of testosterone bioavailability post-LSG, underscoring the need for targeted postoperative monitoring of androgen bioavailability in this population.