HOUSTON—Lifestyle modifications that lead to weight loss may help reduce the prevalence of low testosterone levels by almost 50% in overweight, prediabetic middle-aged men, according to a new study presented at The Endocrine Society's 94th Annual Meeting.

“Doctors should first encourage overweight men with low testosterone levels to try to lose weight through diet and exercise before resorting to testosterone therapy to raise their hormone levels,” said study co-author Frances Hayes, MD, Professor of Medicine at St. Vincent's University Hospital, Dublin, Ireland.

The study involved 891 men with impaired glucose tolerance (IGT) from the Diabetes Prevention Program (DPP). The men were not on medications that interfere with testosterone levels. Of the 891 subjects, 293 were randomized to lifestyle modification, 305 were randomized to receive metformin, and 293 were randomized to placebo. Because overweight men are more likely to have low testosterone levels, Dr. Hayes and her colleagues studied the impact of changes in body weight and insulin sensitivity on serum testosterone levels in men. In a previous study, the researchers had shown that increasing insulin resistance was associated with a decrease in Leydig cell testosterone secretion.

The researchers analyzed anthropometric variables (body mass index [BMI], waist circumference), physical activity (metabolic equivalent hours/week), insulin sensitivity (homeostatic model assessment (HOMA-IR) and reproductive hormone levels (testosterone and luteinizing hormone [LH]) at baseline and at 12 months. Men were excluded from the study if they had a known diagnosis of hypogonadism or were taking medications that could interfere with testosterone levels. Lifestyle modifications consisted of exercising for 150 minutes a week and eating less fat and fewer calories.

The mean age of the men at baseline was 53.9 years and the mean BMI was 31.9 kg/m2.  The researchers observed that the mean testosterone levels (407 ng/dL) were not significantly different among treatment groups at baseline and in the group as a whole did not change (417 ng/dL at 12 months). However, the men randomized to lifestyle modification had a 15% increase in testosterone levels (417 vs. 460 ng/dL). The researchers observed no change in LH (3.1 vs. 3.1 IU/L). Testosterone levels were unchanged in the other two treatment groups.

The overall prevalence of hypogonadal testosterone levels (below 300 ng/dL) at baseline was 23.7%. Through lifestyle modification, the prevalence of hypogonadal testosterone levels decreased from 20.4% to 11.1%, a 46% decline. The prevalence was not significantly changed in the metformin group (24.8% vs. 23.8%) and the placebo group (25.6% vs. 24.6%). Reduction in body weight was greater with lifestyle modification than metformin (-7.8 vs. -2.8 kg), as was the decrease in HOMA-IR (7.0 to 5.2 with lifestyle modification vs. 7.2 to 6.0 with metformin).

Changes in testosterone levels correlated with changes in body weight, waist circumference, and HOMA-IR. They observed no relationship between change in testosterone and physical activity levels. “We didn't see any benefit with exercise. That surprised us. I thought that it would lead to some improvement in testosterone, but we were not able to see any relationship there,” Dr. Hayes told Renal & Urology News.

Men in the lifestyle modification group lost an average of about 17 pounds (7.8 kg) over the one-year study. “Losing weight not only reduces the risk of prediabetic men progressing to diabetes but also appears to increase their body's production of testosterone,” Dr. Hayes said.

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Kalinga provincial hospital chief Dr. Ignacio Cawas said that based on reports, at least 13,000 Filipinos develop end-stage renal disease (ESRD) every year.

He said that in the province, many patients are coming for consultations, but they come too late for treatment because they were not aware of the nature of their disease.

Cawas said that lifestyle is a great factor in acquiring the disease, especially among excessive drinkers and consumers of unhealthy foods.

He also said that this is why kidney disease is prevalent among people with diabetes and hypertension, increasing the risk for a person to suffer heart attack and death.

Cawas said that there is a need to intensify the public’s level of awareness on how to take care of their kidneys and prevent ESRD.
Among the ways, he said, is to drink a lots of water, at least eight glasses a day, to flush out any bacteria or harmful residue in the kidney, and for every individual to observe a healthy lifestyle daily, aside from the regular check-ups with the doctor.

“Renal disease is expensive that even if there is a donor to replace a damaged kidney, this still needs a lot of money for the medicines, operation and continuous treatment,” he said.

Based on the health information profile of the province last year, ESRD is ranked fourth among the top causes of death, with a total of 67 cases where 43 are males and 24 are females.

Ranked first is cardiac vascular arrest/stroke with 146 cases, second is pneumonia with 116 cases, and third is cancer with 106 cases of death.

Through Presidential Decree No. 184 issued by then President Fidel V. Ramos in May of 1993, the month of June is observed all over the country as National Kidney Month.

Leading the nationwide celebration is the National Kidney Institute through the Renal Disease Control Program (REDCOP), geared towards prevention and control of renal and other related diseases in the country.

In support to REDCOP, the Department of the Interior and Local Government ordered all governors and all city and municipal mayors to designate their provincial city and municipal REDCOP coordinators to conduct fora on renal health and renal disease prevention; and spearhead activities to promote such. (JDP/GGD-PIA CAR, Kalinga)

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