It should be noted that testosterone deficiency is associated with a shift in fuel metabolism from lipid oxidation toward glucose utilization  and testosterone therapy [51,120] increased muscle mass and lipid oxidation in aging men. Furthermore, higher endogenous circulating testosterone levels were associated with reduced loss of LBM in elderly men  and testosterone therapy in frail men preserves muscle thickness . Thus, it is not surprising that in obese men with testosterone deficiency, long-term testosterone therapy with formulations that achieve physiological levels, along with adequate adherence, produced significant and sustained weight loss, concomitant with reduction in waist circumference and BMI (Table 2, Figs 1 and 2) [23▪▪,27–44,45▪,46▪▪,47–56,57▪,58▪▪–61▪▪,62▪,63▪,64–66,72]. Further, long-term testosterone therapy in men with testosterone deficiency produced improvements in cardio-metabolic function, ameliorated MetS components, reduced fatigue, increased vigor and energy and improved quality of life [62▪,63▪,64–66,103▪▪,104–107,123]. We suggest that testosterone therapy offers well tolerated and effective treatment of obesity in men with testosterone deficiency and this novel approach provides a unique opportunity to manage obese men. Other therapeutic targets for the treatment of obesity have been proposed including hypothalamic malonyl-CoA and CPT1c [124,125] and GLP-1, oxyntomodulin, peptide YY, gastric inhibitory peptide and ghrelin . These targets may prove useful in addition to testosterone therapy.
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