Did you know that people living with obesity can sometimes develop low testosterone levels, and vice versa? Testosterone is a sex hormone, a chemical that sends messages in the body. Among many other functions, it regulates muscle growth and how fat is stored.

Read on to learn more about how obesity and testosterone levels are connected, the symptoms of low testosterone, and what you can do if you develop low levels of this hormone.

Testosterone: One Hormone, Many Functions

Everyone has some testosterone. Males generally have higher total testosterone levels than females. For females, the main sex hormone is usually estradiol.

In both females and males, testosterone increases sexual drive. In males, it drives the development of sexual features and muscle mass during puberty, according to Cleveland Clinic. Testosterone supports muscle growth and repair by encouraging the production of proteins — muscle-building units. In the adipose tissue, which stores fat cells, it breaks down fat. Plus, testosterone stops cells from maturing and storing more fat. In these ways, testosterone helps control weight and reduces the risk of obesity.

Obesity is defined as having a body mass index (BMI) or 30 or higher. According to the Centers for Disease Control and Prevention (CDC), more than 2 in 5 people in the United States live with obesity.

Obesity can both cause and be caused by low testosterone levels. Luckily, research shows that low testosterone levels are reversible. Lifestyle changes and testosterone medications can help regulate levels and reduce symptoms of low testosterone.

How Does the Body Produce Testosterone?

Imagine having three dominoes that must fall in order to release testosterone. These three dominoes are:

• The hypothalamus — The area of your brain that controls body temperature
• The pituitary gland — A pea-sized structure under the hypothalamus
• The gonads (sex organs) — Testicles or ovaries

First, your hypothalamus sends a signal to the pituitary gland. This structure releases chemicals that make your sex organs produce testosterone. Finally, testosterone is released, and when your body detects it in your blood, production of the hormone is stopped. This feedback ensures balanced testosterone levels in your body.

Obesity and Testosterone: A Vicious Cycle

The cause-and-effect link between testosterone and obesity is complex, and it goes both ways. Low testosterone can contribute to obesity, and obesity can lower testosterone levels.

Does Obesity Cause Low Testosterone?

Too much fat storage activates aromatase, a protein that converts testosterone into estradiol. A negative feedback loop controls estradiol and testosterone. When estradiol levels increase, the body tells the brain to limit testosterone release.

Scientists also suggest that obesity-related visceral fat (more commonly known as belly fat) affects the release of testosterone. According to this hypothesis, obesity drives inflammation, insulin resistance, and diabetes.

Also, people with obesity and insulin resistance often produce less of a protein called sex hormone-binding globulin (SHBG). SHBG carries testosterone in the blood. With less SHBG, there is also less free testosterone available for body functions.

Does Testosterone Cause Obesity?

Testosterone and SHBG levels are related to a health condition called metabolic syndrome. Metabolic syndrome includes obesity, heart and blood vessel disease, and hypertension (high blood pressure). Studies have shown that people with diabetes and low testosterone may develop obesity, insulin resistance, and inflammation.

What Are the Symptoms of Low Testosterone?

Low levels of testosterone affect body composition (ratio of muscle to fat) by decreasing muscle mass. As muscle shrinks, people with low testosterone might lose strength and feel weaker.

A decrease in testosterone also influences sleep and sexual desire. According to the Asian Journal of Andrology, men with obesity and low testosterone may develop sleep apnea, a condition where they stop breathing for short periods. Lower testosterone can also reduce sex drive and cause erectile dysfunction in men, according to Cleveland Clinic.

All of these factors can influence energy and mood. According to the journal Comprehensive Psychoneuroendocrinology, low testosterone can increase the risk of depression in men and is more likely to trigger hunger problems — either loss of appetite or overeating — in women.

Managing Low Testosterone Levels

It’s possible to reverse low testosterone levels. Losing weight is often key to improving hormone balance. Lifestyle changes, treatment, and surgery are approaches you might consider if you want to lose weight and restore testosterone balance.

Lifestyle Changes To Improve Testosterone Levels

If you’re living with low testosterone levels and obesity, the first thing to consider is your lifestyle. Some guidelines to manage body weight and improve testosterone levels include:

• Eating a healthier diet
• Staying physically active
• Quitting smoking
• Reducing alcohol
• Sleeping more

It can be difficult to choose the right diet. Consider adopting a Mediterranean diet, which avoids the large amounts of dairy, bread, and sweets eaten in a typical Western diet. A Western diet can testosterone and increases insulin and body weight. Low-fat and high-protein diets also reduce testosterone, making it difficult to choose the right plan. If you’re having trouble knowing where to start making changes to your diet, ask your doctor for a referral to a registered dietitian.

Diet changes and physical exercise can increase testosterone levels. Both aerobic (running) and anaerobic (weight lifting) workouts have benefits. A 2024 study in Sports Medicine found that aerobic training helped men with obesity and diabetes manage calories and testosterone.

Alcohol, smoking, and sleep affect mood, energy, and sexual activity. Smoking and drinking alcohol reduce sexual desire and functions. People with low testosterone are generally advised to quit or reduce smoking and drinking. As people release most testosterone during sleep, sleeping seven to nine hours per night might help with testosterone levels.

Testosterone Replacement Therapy

Testosterone replacement therapy (TRT) is a medical treatment that provides testosterone to men who have hypogonadism (low levels of this hormone). It works well for some people with symptoms of low testosterone levels, though it is not recommended as a treatment for obesity.

Men with low testosterone who receive TRT often lose weight and have a smaller waist size, according to the journal Current Opinion in Endocrinology & Diabetes and Obesity. TRT also helps muscle growth, leading to better physical performance, vigor, and motivation.

There are several situations where testosterone therapy is not appropriate. This includes situations of men who want to have children and those with prostate cancer, untreated sleep apnea, uncontrolled heart failure, recent strokes or heart attacks. It also may not be suitable for men over 65.

A large clinical trial of men with low testosterone and existing or high risk of cardiovascular disease found that testosterone therapy did not increase the risk of major heart events compared to placebo (inactive treatment). However, the therapy was linked to higher rates of atrial fibrillation (irregular heartbeats), kidney problems, and pulmonary embolism (blood clots in the lungs).”

GLP-1 Agonists

Glucagon-like peptide 1 agonists (or GLP-1 agonists) are newer drugs used to reduce weight and lower blood sugar levels in people with type 2 diabetes. Drugs in this category include semaglutide, liraglutide, and exenatide. These drugs are usually injected.

Some studies have shown that low testosterone levels in men with obesity improved after treatment with liraglutide.

Weight Loss Surgery and Weight Management

Bariatric surgery, which is performed to help people lose weight, is another option for people diagnosed with obesity and low testosterone levels. It limits how much and what type of food a person can eat and how much of it the body takes in. In people diagnosed with obesity, bariatric surgery can help to reach up to 30 percent of weight loss. It can also keep weight and testosterone at optimal levels after two years of surgery. However, this approach is invasive and expensive.

Talking to Your Doctor About Testosterone Levels

If you’re concerned you may have developed low testosterone levels along with obesity, the first step is to talk to your doctor. They may order a blood test to check your hormone levels. The blood sample will need to be taken in the morning, and if the results show testosterone deficiency, you and your healthcare team can discuss next steps. You may be able to make lifestyle changes and get treatment that will help you feel better and stay healthier.

Find Your Team

MyObesityTeam is the social network and online support group for people with obesity and their loved ones. Here, more than 56,000 members come together to share experiences, seek advice, and offer support.

Have you noticed symptoms of low testosterone along with obesity? Have you asked your doctor to test your hormone levels? Comment below, share on your Activities feed, or connect with like-minded members in Groups.