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First, MOSH has been normally defined as low circulating testosterone levels with normal or reduced gonadotropins in the majority of the studies, without evaluating semen quality (Hofstra et al., 2008 Dhindsa et al., 2010). However, there are still some controversies regarding how obesity affects gonadal function and fertility in men and what are the best options for treatment (Stokes et al., 2015). Therefore, it is not surprising why MOSH have been recently proposed as an indication for bariatric surgery (Lucchese & Maggi, 2013 Samavat et al., 2014).
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The latter has been confirmed by a recent meta-analysis showing that bariatric surgery induces an increase in both total testosterone (TT) and free testosterone (FT), the normalization of serum sex hormone-binding globulin (SHBG), and the remission of MOSH in a large proportion of patients (Corona et al., 2013). Of note, the marked weight loss that occurs after bariatric surgery results into remission of the hormonal derangements present in PCOS (Escobar-Morreale et al., 2005) and MOSH (Botella-Carretero et al., 2013 Calderon et al., 2014 Samavat et al., 2014) in almost all patients.
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PCOS and MOSH have been found in approximately 50% and 60% of severely obese female and male patients submitted to bariatric surgical procedures (Escobar-Morreale et al., 2005 Calderon et al., 2014). Obesity is also associated with gonadal dysfunction, including polycystic ovary syndrome (PCOS) and male obesity-associated secondary hypogonadism (MOSH) (Alvarez-Blasco et al., 2006 Saboor Aftab et al., 2013). Obesity is a significant risk factor for increased mortality, mainly because of its association with diabetes, cardiovascular disease and cancer (Berrington de Gonzalez et al., 2010). The prevalence of overweight and obesity have increased markedly during the past decades, reaching epidemic figures (Finucane et al., 2011). Semen analysis must be performed in these patients when considering fertility whether or not presenting low circulating testosterone. Low circulating testosterone is associated with insulin resistance and low ejaculate volume with higher BMI and excess body weight. Our data show the prevalence of MOSH in patients with moderate to severe obesity is high. The frequencies of low TT or low FT values were similar in patients with abnormal or normal semen analysis ( p = 0.646 and p = 0.346, respectively). Sixty-two percent (95% CI: 39–85%) of the patients with seminogram also presented abnormal results in semen analysis. Serum concentrations of TT were correlated negatively with glucose ( r = −0.328, p < 0.001) and insulin resistance ( r = −0.261, p = 0.011). We found a prevalence of 45% (95% CI: 35–55%) when considering decreased TT and/or FT concentrations. Semen analysis was conducted in 31 patients. Serum-free testosterone (FT) concentration was calculated from TT and SHBG levels. Total testosterone (TT) and sex hormone-binding globulin (SHBG) concentrations among others were assayed in all patients. To study the prevalence of male obesity-secondary hypogonadism (MOSH) in patients with moderate to severe obesity, we performed a prospective prevalence study including 100 male patients with moderate to severe obesity at a university tertiary hospital.