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Bariatric surgery and virility

Bariatric surgery increases virility but not sperm quality

Bariatric surgery appears to be effective in increasing male sex hormones and decreasing female sex hormones in obese male patients

Men who have undergone bariatric surgery as a long-term way of losing weight might also benefit from increased testosterone levels post-surgery. The research, led by Drs Shahzeer Karmali and was a collaborative effort between Yung Lee of McMaster University and Jerry Dang of the University of Alberta in Canada, also found that there is no evidence that the sperm quality of a patient improves.

The paper, ‘Impact of Bariatric Surgery on Male Sex Hormones and Sperm Quality: a Systematic Review and Meta-Analysis’, published in Obesity Surgery, was a systematic review and meta-analysis sought to establish the effects of bariatric surgery on male sex hormones, sperm parameters, and sexual function.

"As the prevalence of both male infertility and bariatric surgery increases, knowledge of how surgical intervention affects fertility outcomes may better inform patient and surgeon decisions on pursuing this procedure," explained Lee.

Hormonal changes, a drop in sexual functioning, and less satisfaction in bed are among the many downsides of obesity. Obese men in particular are known to experience lower testosterone levels, lower sexual satisfaction, and reduced fertility compared to men of normal weight. On average the odds of male infertility are said to increase by 10 per cent for every nine kilograms a man is overweight.

Up until now most studies on the relationship between fertility and bariatric surgery have been focused on women. So Lee and his colleagues set out to review the available research on the influence of this procedure on male sex hormones and sperm quality.

The literature review identified 28 cohort studies with 1,022 patients were identified from 3,896 potentially relevant citations. The studies all examined the effect of bariatric surgery on male sex hormones or sperm characteristics in patients with obesity.

Lee and his colleagues found that patients' free and calculated testosterone levels were significantly increased after bariatric surgery (p<0.001). Consistent with an increase in testosterone, levels of the hormones LH, FSH, and SHBG were also boosted. The amount of the female sex hormones oestradiol and prolactin also notably dropped. These hormonal changes meant that erectile function also significantly increased after bariatric surgery. However, sperm characteristics such as volume, concentration, ability to move and build did not change much after bariatric surgery. In fact, several cases reported the worsening of such sperm parameters.

Both free and calculated testosterone levels were significantly increased after bariatric surgery (p<0.001). Consistent with the increase in testosterone, LH, FSH, and SHBG levels were also significantly increased after surgery.

From studies that reported the IIEF score, bariatric surgery led to a significant increase in erectile function after surgery (p=0.04). However, bariatric surgery did not affect sperm quality, DHEA, androstenedione and inhibin B levels.

"This may be because any positive hormonal changes after bariatric surgery are counterbalanced by nutritional malabsorption and insufficiencies. Bariatric surgery appears to be effective in increasing male sex hormones and decreasing female sex hormones in obese male patients,” concluded Lee. “However, our review also suggests that bariatric surgery has no benefits on sperm parameters. Long-term comparative studies or adequately powered randomised controlled trials are warranted to further examine the impact of bariatric surgery on male sex hormones and sperm quality."

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