We discuss androgens, bariatric surgery, and its relationship with nutrients and male reproduction

What is it about?

Androgens and estrogens play a key role regarding sexual life and reproduction. Along with hypotestosteronemia, obese men exhibit a 2-fold increase in estradiol concentration, adversely influencing these parameters. Estrogens and adipokines also influence bone metabolism, exerting a direct effect on vitamin D, calcium homeostasis and bone health. Bariatric procedures normalize some sex hormones, and may reverse several obesity-related conditions. However, few studies have addressed changes in sex hormones and in reproductive function in the male bariatric population, as they represent a minority of surgical candidates.

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Why is it important?

Bariatric procedures may revert many of the deleterious phenomena of obesity, and normalize some sex hormones, with lasting effects. Estrogens levels, however, may remain elevated, depending on insufficient weight loss or weight regain, in the late follow-up period. Micronutrient deficiencies are maintained in the long term after bariatric surgery, and need to be carefully addressed with life-long nutritional monitoring and specific prophylactic supplementation, in addition to the recommended over-the-counter vitamin and mineral supplementation. Preliminary findings concerning impaired semen quality are worrisome, and additional studies investigating the role of zinc, adipokines and gut hormones on the reproductive potential of men after bariatric surgery are necessary.

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