{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T14:11:10Z","timestamp":1785593470330,"version":"3.56.0"},"reference-count":70,"publisher":"The Endocrine Society","license":[{"start":{"date-parts":[[2021,7,15]],"date-time":"2021-07-15T00:00:00Z","timestamp":1626307200000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Context<\/jats:title><jats:p>Although gonadal axis dysregulation from energy deficit is well recognized in women, the effects of energy deficit on the male gonadal axis have received much less attention.<\/jats:p><\/jats:sec><jats:sec><jats:title>Evidence acquisition<\/jats:title><jats:p>To identify relevant articles, we conducted PubMed searches from inception to May 2021.<\/jats:p><\/jats:sec><jats:sec><jats:title>Evidence synthesis<\/jats:title><jats:p>Case series and mechanistic studies demonstrate that energy deficit (both acutely over days or chronically over months) either from inadequate energy intake and\/or excessive energy expenditure can lower serum testosterone concentration as a result of hypothalamic-pituitary-testicular (HPT) axis dysregulation in men. The extent to which this has clinical consequences that can be disentangled from the effects of nutritional insufficiency, concomitant endocrine dysregulation (eg, adrenal and thyroid axis), and coexisting comorbidities (eg, depression and substance abuse) is uncertain. HPT axis dysfunction is primarily the result of loss of GnRH pulsatility resulting from a failure of leptin to induce kisspeptin signaling. The roles of neuroendocrine consequences of depression, hypothalamic-pituitary-adrenal axis activation, proinflammatory cytokines, Ghrelin, and genetic susceptibility remain unclear. In contrast to hypogonadism from organic pathology of the HPT axis, energy deficit-associated HPT dysregulation is functional, and generally reversible by restoring energy balance.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The clinical management of such men should aim to restore adequate nutrition and achieve and maintain a healthy body weight. Psychosocial comorbidities must be identified and addressed. There is no evidence that testosterone treatment is beneficial. Many knowledge gaps regarding epidemiology, pathophysiology, and treatment remain and we highlight several areas that require future research.<\/jats:p><\/jats:sec>","DOI":"10.1210\/clinem\/dgab517","type":"journal-article","created":{"date-parts":[[2021,7,15]],"date-time":"2021-07-15T15:31:57Z","timestamp":1626363117000},"source":"Crossref","is-referenced-by-count":11,"title":["Dysregulation of the Hypothalamic-Pituitary-Testicular Axis due to Energy Deficit"],"prefix":"10.1210","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8261-3457","authenticated-orcid":false,"given":"Mathis","family":"Grossmann","sequence":"first","affiliation":[{"name":"Department of Medicine (Austin Health), The University of Melbourne, Victoria, Australia"},{"name":"Department of Endocrinology, Austin Health, Heidelberg, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6818-6065","authenticated-orcid":false,"given":"Gary A","family":"Wittert","sequence":"additional","affiliation":[{"name":"Freemasons Centre for Male Health and Well-being, University of Adelaide, Adelaide, South Australia, Australia"},{"name":"The Queen Elizabeth Hospital, Woodville, South Australia, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"80","published-online":{"date-parts":[[2021,7,15]]},"reference":[{"key":"2021080513404287600_CIT0001","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1093\/jn\/19.5.493","article-title":"Pseudohypothysectomy: a condition resembling hypothysectomy produced by malnutrition","volume":"19","author":"Mulinos","year":"1940","journal-title":"J Nutr"},{"issue":"1","key":"2021080513404287600_CIT0002","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1210\/jcem-73-1-35","article-title":"Slowing of pulsatile luteinizing hormone secretion in men after forty-eight hours of fasting","volume":"73","author":"Cameron","year":"1991","journal-title":"J Clin Endocrinol 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