Sexual hormones and erectile function more than 6 years after bariatric surgery

doi:10.1016/j.soard.2012.06.010

Surgery for Obesity and Related Diseases

Volume 9, Issue 5, September–October 2013, Pages 636-640

https://doi.org/10.1016/j.soard.2012.06.010 Get rights and content

Abstract

Background

The long-term effect of bariatric intervention on androgenic hormones and erectile function is not well known. In a prospective comparative study, the profile of sexual function was ascertained. The setting was a large public academic hospital.

Methods

A total of 51 patients were included in the present study. Of these, 23 were in the bariatric surgery cohort (with 6–14 yr of follow-up), 14 were obese controls, and 14 were lean controls, aged 30–65 years. The groups were matched for age and, in the case of obese controls, the current body mass index. The measurements included orchidometry, an assessment of gynecomastia, the International Index of Erectile Function, the Aging Males Symptoms questionnaire, the measurement of 12 hormones, and general biochemical measurements.

Results

Bariatric patients lost substantial weight (59.8 ± 12.1 versus 35.1 ± 7.7 kg/m²), albeit residual obesity was the rule, with varying degrees of sleep apnea, hypertension, and glucose/lipid aberrations. The total and free testosterone and sex hormone-binding globulin levels were greater in the gastric bypass patients than in the obese controls and comparable to those of lean individuals. The International Index of Erectile Function final score revealed no differences; however, the domains of erectile dysfunction (P = .015) and overall satisfaction (P = .028) were better than those in the obese controls, although still lower than those in the lean group. The correlation between the body mass index and the International Index of Erectile Function score in the entire population (n = 51) was negative, as expected, with, however, low r and r² indexes (.354 and .125, respectively).

Conclusion

The findings are consistent with long-term normalization of androgenic hormones but less than complete normalization of erectile function. This seeming contradiction might be explained by the remaining or relapsing obesity or its co-morbidities.

Section snippets

Experimental design, eligibility, and patient enrollment

This was a prospective, observational, controlled cohort study. Male patients (n = 51) were consecutively recruited for clinical and biochemical assessment, including retrospective information collected from the hospital files. The inclusion criteria were age 30–65 years and informed consent. The exclusion criteria were additional surgical procedures or “take down” of the original operation (bariatric cohort), a history of pituitary, adrenal, thyroid, or testicular disorders, the use of

Results

All patients agreed to the protocol, and there were no exclusions. No patient was addicted to alcohol or drugs, and the proportion of smokers was not different among the 3 groups (21.7%, 21.4%, and 13.3%, P = .512). The follow-up duration in the bariatric cohort was 115.5 ± 35.6 months (range 80–195), and the BMI decrease was remarkable, although still in the obese range, suggesting weight regain (58.1 ± 12.1 versus 35.1 ± 7.7 kg/m², P < .001).

The principal results are listed in Table 1. No

Discussion

Obesity affects all levels of the hypothalamic-pituitary-gonadal axis, resulting, not only in androgen deficiency and erectile dysfunction, but also infertility [2]. Sexual activity is highly relevant for health and quality of life in both middle-age and elderly men and has been associated with an increased life span [4]. To the best of our knowledge, the present study is the first investigation revealing that the androgen results found shortly after bariatric interventions are long-lasting

Conclusion

The patients who had undergone Roux-en-Y gastric bypass 6–16 years earlier displayed elevated total and free testosterone and SHBG levels compared with those in the obese controls and comparable to those in the lean controls. In contrast, the erectile function scores were inferior to those of the lean controls, suggesting incomplete functional restoration. Relapsing obesity and recurring co-morbidities might explain such an outcome [9], [10], [11].

Disclosures

The authors have no commercial associations that might be a conflict of interest in relation to this article.

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There are more references available in the full text version of this article.

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What Is the Impact of Bariatric Surgery on Erectile Function? A Systematic Review and Meta-Analysis
2017, Sexual Medicine Reviews
Citation Excerpt :
No article was retrieved from searches in textbooks, theses, and references from other articles. The selection process is demonstrated in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram (Figure 1),9 and reasons for excluding the retrieved full articles are listed in Table 1.10–21 The study designs and the methods used in each study are presented in Table 2.
Obesity is a worldwide public health issue that has severe psychological and social implications. Erectile dysfunction also is a prevalent clinical situation, and obesity is one of the primary risk factors for its development.
To determine whether bariatric surgery can lessen erectile dysfunction in obese men because of evidence showing that weight loss in obese men contributes to decreasing erectile dysfunction and bariatric surgery contributes to significant weight loss.
A search was conducted using Medline, LILACS, Cochrane, Scopus, CINAHL, Embase, Web of Science, Eric, and EBM up to April 13, 2016. The authors selected by title, abstract, and full text. Scottish Intercollegiate Guidelines Network checklists were used for comparative studies to show the limitations and biases of each article. RevMan 5.3 software from the Cochrane Library was used for meta-analyses. Results were demonstrated with forest plots.
The outcome selected was resolution of erectile dysfunction, which was analyzed by improvement in the International Index of Erectile Function (IIEF) score.
Of 185 articles analyzed, 7 were selected for systematic review. Meta-analysis of two articles that evaluated erectile function showed a 5.66-point increase in the five-item IIEF score of patients who underwent bariatric surgery (95% CI = 7.88–3.45, I² = 35%, P < .00001), demonstrating statistical significance. Meta-analysis of three articles showed a 4.10-point increase in the IIEF erectile function score of patients who underwent bariatric surgery (95% CI = 6.10–2.10, I² = 0%, P < .0001), demonstrating statistical significance.
Bariatric surgery leads to an improvement of erectile function.
Glina FPI, de Freitas Barboza JW, Nunes VM, et al. What Is the Impact of Bariatric Surgery on Erectile Function? A Systematic Review and Meta-Analysis. Sex Med Rev 2017;5:393–402.
Recommendations for the presurgical psychosocial evaluation of bariatric surgery patients
2016, Surgery for Obesity and Related Diseases
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Improved physical and mental quality of life are strong motivators for patients seeking WLS [215]. Numerous studies have found significant improvements in health- and weight-related quality of life after surgery [14,200–202,213,216–233], including specific domains such as occupational [234] and sexual [235] functioning. Assessing the impact of weight on quality of life provides insight as to the reasons patients have for seeking bariatric surgery, and this may have implications for their expectations about surgery outcome.
Psychosocial factors have significant potential to affect long-term outcomes of bariatric surgery, including emotional adjustment, adherence to the recommended postoperative lifestyle regimen, weight loss outcomes, and co-morbidity improvement and or resolution. Thus, it is recommended that bariatric behavioral health clinicians with specialized knowledge and experience be involved in the evaluation and care of patients both before and after surgery. The evaluating clinician plays a number of important roles in the multidisciplinary treatment of the bariatric patient. Central among these is the role of identifying factors that may pose challenges to optimal surgical outcome and providing recommendations to the patient and bariatric team on how to address these issues. This document outlines recommendations for the psychosocial evaluation of bariatric surgery patients, appropriate qualifications of those conducting these evaluations, communication of evaluation results and suggested treatment plan, and the extension of behavioral healthcare of the bariatric patient to the entire span of the surgical and postsurgical process.
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Obesity is a complex metabolic condition that is dramatically increasing worldwide in men and women in their reproductive age (with a male:female ratio of 2:3), representing not only a medical and health problem, but also a social and economic burden due to the numerous associated morbidities. Here, we review the current knowledge about reproductive alterations in obese males, considering sex hormone profile, semen parameters, sperm functional properties, in vitro fertilization outcome, as well as sexual quality of life and erectile function. Moreover, we analyze the current literature on the effects of bariatric surgery on these reproductive aspects affecting morbidly obese men. We conclude that evidence exists that symptomatic hypogonadotropic hypogonadism, associated with male obesity, can be significantly reverted – and sex steroid hormone levels equilibrated – by bariatric surgery, thus suggesting this andrological pathology as a potential additional indication to bariatric surgery.
Improvement in Erectile Dysfunction Among Male Obese Patient, Following Bariatric Surgery in Hospital Canselor Tuanku Muhriz (HUKM)
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: Supported in part by a grant from the Brazilian National Research Council (PQ2 - JF) 302915/2011-7.

: Supported in part by National Council for Scientific and Technological Development (grant 302915/2011-7).

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Original articleSexual hormones and erectile function more than 6 years after bariatric surgery

Abstract

Background

Methods

Results

Conclusion

Section snippets

Experimental design, eligibility, and patient enrollment

Results

Discussion

Conclusion

Disclosures

Gend Med

Surg Obes Relat Dis

Androgens and obesity

Curr Opin Endocrinol Diabetes Obes

Effects of bariatric surgery on urinary and sexual function

BJU Int

Sex, health, and years of sexually active life gained due to good health: evidence from two US population based cross sectional surveys of ageing

BMJ

Original article
Sexual hormones and erectile function more than 6 years after bariatric surgery