{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T21:45:06Z","timestamp":1777585506118,"version":"3.51.4"},"reference-count":29,"publisher":"ALUNA","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,4,1]]},"abstract":"<jats:p>Functional hypogonadism in men is a syndrome characterized by low testosterone levels and clinical signs of hypogonadism without organic disease of the hypothalamus-pituitary-gonadal axis. It is most often caused by obesity, diabetes type 2, exogenous steroid abuse, excessive physical exercise, opioid use, co-occurring diseases, and is most prevalent among middle-aged and older men as so-called late-onset hypogonadism. It seems that the most important epidemiological factor causing functional hypogonadism is excess adipose tissue. Obesity is currently one of the most important public health problems and its prevalence is higher in men than in women. Complications of obesity include not only cardiovascular diseases or type 2 diabetes mellitus, but also lead to decreased testosterone levels, reduced libido and erectile dysfunctions, and impaired fertility in men. These disorders in men with obesity are associated with decreased gonadotropins and testosterone secretion due to hyperinsulinemia, hyperleptinemia, chronic inflammation and oxidative stress. Currently, it seems that an important complication of obesity is the deterioration of semen parameters (sperm concentration, motility, and morphology) and reduced fertility. Theoretically, obesity-related functional hypogonadism in men is reversible, so the basis of initial treatment is primarily lifestyle modification and effective treatment of chronic diseases but primarily reducing body fat mass (physical exercise and low-caloric diet). Unfortunately, lifestyle changes are often insufficient to significantly increase testosterone levels and resolve the clinical symptoms of hypogonadism. Because in men seeking fertility conventional testosterone replacement therapy is contraindicated, alternative pharmacological methods, such antiestrogens (selective estrogen receptor modulators and aromatase inhibitors) are often used.<\/jats:p>","DOI":"10.36740\/merkur202602119","type":"journal-article","created":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T20:00:26Z","timestamp":1777406426000},"page":"229","source":"Crossref","is-referenced-by-count":0,"title":["Effectiveness and safety of antiestrogens in the treatment of functional hypogonadism in men with obesity"],"prefix":"10.36740","volume":"54","author":[{"given":"Marcin","family":"Rabijewski","sequence":"first","affiliation":[{"name":"DEPARTMENT OF REPRODUCTIVE HEALTH, CENTER OF POSTGRADUATE MEDICAL EDUCATION, WARSAW, POLAND"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jakub","family":"Wydra","sequence":"additional","affiliation":[{"name":"DEPARTMENT OF REPRODUCTIVE HEALTH, CENTER OF POSTGRADUATE MEDICAL EDUCATION, WARSAW, POLAND"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Grzegorz","family":"Kapu\u015bci\u0144ski","sequence":"additional","affiliation":[{"name":"DEPARTMENT OF UROLOGY, MAZOVIAN ONCOLOGICAL HOSPITAL, WARSAW, POLAND"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Micha\u0142","family":"Rabijewski","sequence":"additional","affiliation":[{"name":"DEPARTMENT OF REPRODUCTIVE HEALTH, CENTER OF POSTGRADUATE MEDICAL EDUCATION, WARSAW, POLAND"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"22436","published-online":{"date-parts":[[2026,4,1]]},"reference":[{"key":"ref0","doi-asserted-by":"crossref","unstructured":"1. Grossmann M, Matsumoto AM. A Perspective on Middle-Aged and Older Men with Functional Hypogonadism: Focus on Holistic Management. J Clin Endocrinol Metab 2017;102(3):1067-1075 doi: 10.1210\/jc.2016-3580.","DOI":"10.1210\/jc.2016-3580"},{"key":"ref1","doi-asserted-by":"crossref","unstructured":"2. Salonia A, Bettocchi C, Boeri L, et al. European Association of Urology Guidelines on Sexual and Reproductive Health-2021 Update: Male Sexual Dysfunction. Eur Urol. 2021;80(3):333-357 doi: 10.1016\/j.eururo.2021.06.007.","DOI":"10.1016\/j.eururo.2021.06.007"},{"key":"ref2","doi-asserted-by":"crossref","unstructured":"3. De Lorenzo A, Noce A, Moriconi E et al. MOSH Syndrome (Male Obesity Secondary Hypogonadism): Clinical Assessment and Possible Therapeutic Approaches. Nutrients. 2018;10(4) doi: 10.3390\/nu10040474.","DOI":"10.3390\/nu10040474"},{"key":"ref3","doi-asserted-by":"crossref","unstructured":"4. Wu F.C, Tajar A, Beynon JM, et al. Identification of late-onset hypogonadism in middle-aged and elderly men. N Engl J Med. 2010;363(2):123-35 doi: 10.1056\/NEJMoa0911101","DOI":"10.1056\/NEJMoa0911101"},{"key":"ref4","unstructured":"5. Wojtyniak B, Gory\u0144ski P. (red.) Sytuacja zdrowotna ludno\u015bci Polski i jej uwarunkowania. Narodowy Instytut Zdrowia Publicznego \u2013 Pa\u0144stwowy Zak\u0142ad Higieny. Warszawa 2020"},{"key":"ref5","doi-asserted-by":"crossref","unstructured":"6. Corona G, Goulis DG, Huhtaniemi I, et al. European Academy of Andrology (EAA) guidelines on investigation, treatment and monitoring of functional hypogonadism in males: Endorsing organization: European Society of Endocrinology. Andrology. 2020;8(5):970-987 doi: 10.1111\/andr.12770.","DOI":"10.1111\/andr.12770"},{"key":"ref6","doi-asserted-by":"crossref","unstructured":"7. Fui MN, Dupuis P, Grossmann M. Lowered testosterone in male obesity: mechanisms, morbidity and management. Asian J Androl. 2014; 2:223-31. doi: 10.4103\/1008-682X.122365.","DOI":"10.4103\/1008-682X.122365"},{"key":"ref7","doi-asserted-by":"crossref","unstructured":"8. Cohen P. The hypogonadal \u2013 obesity cycle: role of aromatase in modulating the testosterone\u2013estradiol shunt \u2013 a major factor in the genesis of morbid obesity. Med Hypotheses. 1999;1: 49-51. doi: 10.1054\/mehy.1997.0624.","DOI":"10.1054\/mehy.1997.0624"},{"key":"ref8","doi-asserted-by":"crossref","unstructured":"9. Rabijewski M. Male-specific consequences of obesity - functional hypogonadism and fertility disorders. Endokrynol Pol. 2023;74(5): 480-489 doi: 10.5603\/ep.95626.","DOI":"10.5603\/ep.95626"},{"key":"ref9","doi-asserted-by":"crossref","unstructured":"10. Grossmann M. Hypogonadism and male obesity: Focus on unresolved questions. Clin Endocrinol (Oxf). 2018;1: 11-21. doi: 10.1111\/cen.13723","DOI":"10.1111\/cen.13723"},{"key":"ref10","doi-asserted-by":"crossref","unstructured":"11. Clarke H, Dhillo WS, Jayasena CN. Comprehensive review on kisspeptin and its role in reproductive disorders. Endocrinol Metab (Seoul). 2015; 2:124-41. doi: 10.3803\/EnM.2015.30.2.124.","DOI":"10.3803\/EnM.2015.30.2.124"},{"key":"ref11","doi-asserted-by":"crossref","unstructured":"12. Acevedo-Rodriguez A, Kauffman AS, Cherrington BD, et al. Emerging insights into hypothalamic-pituitary-gonadal axis regulation and interaction with stress signalling. J Neuroendocrinol. 2018; 30(10): e12590 doi: 10.1111\/jne.12590.","DOI":"10.1111\/jne.12590"},{"key":"ref12","doi-asserted-by":"crossref","unstructured":"13. Koehler K, Hoerner NR, Gibbs .C, et al. Low energy availability in exercising men is associated with reduced leptin and insulin but not with changes in other metabolic hormones. J Sports Sci. 2016; 34(20):1921-9 doi: 10.1080\/02640414.2016.1142109.","DOI":"10.1080\/02640414.2016.1142109"},{"key":"ref13","doi-asserted-by":"crossref","unstructured":"14. Ide V, Vanderschueren V, Antonio L. Treatment of men with central hypogonadism: alternatives for testosterone replacement therapy. Int J Mol Sci. 2020;22(1) doi: 10.3390\/ijms22010021.","DOI":"10.3390\/ijms22010021"},{"key":"ref14","doi-asserted-by":"crossref","unstructured":"15. Tienforti D, Castellini C, Di Giulio F, et al. Selective modulation of estrogen receptor in obese men with androgen deficiency: A systematic review and meta-analysis. Andrology. 2023;11(6):1067-1076 doi: 10.1111\/andr.13373.","DOI":"10.1111\/andr.13373"},{"key":"ref15","doi-asserted-by":"crossref","unstructured":"16. Huijben M, Lock M, de Kemp VF, et al. Clomiphene citrate: A potential alternative for testosterone therapy in hypogonadal males. Endocrinol Diabetes Metab. 2023;6(3): e416 doi: 10.1002\/edm2.416.","DOI":"10.1002\/edm2.416"},{"key":"ref16","doi-asserted-by":"crossref","unstructured":"17. Krzastek SC, Sharma D, Abdullah N, et al. Long-Term Safety and Efficacy of Clomiphene Citrate for the Treatment of Hypogonadism. J Urol; 2019;202(5):1029-1035 doi: 10.1097\/JU.0000000000000396.","DOI":"10.1097\/JU.0000000000000396"},{"key":"ref17","doi-asserted-by":"crossref","unstructured":"18. Keihani S, Wright LN, Alder A, et al. Baseline Gonadotropin Levels and Testosterone Response in Hypogonadal Men Treated with Clomiphene Citrate. Urology. 2020; 142:119-124 doi: 10.1016\/j.urology.2020.04.074.","DOI":"10.1016\/j.urology.2020.04.074"},{"key":"ref18","doi-asserted-by":"crossref","unstructured":"19. Masterson JM, Cohen J, Blachman-Braun R. et al. Pre-treatment estradiol does not predict testosterone response to clomiphene citrate. Transl Androl Urol.2020;9(2):609-613 doi: 10.21037\/tau.2020.01.30.","DOI":"10.21037\/tau.2020.01.30"},{"key":"ref19","doi-asserted-by":"crossref","unstructured":"20. Huijben M, Huijsmans RLN, Lock M, et al. Clomiphene citrate for male infertility: A systematic review and meta-analysis. Andrology. 2023;11(6): 987-996 doi: 10.1111\/andr.13388.","DOI":"10.1111\/andr.13388"},{"key":"ref20","doi-asserted-by":"crossref","unstructured":"21. Al Wattar BH, Rimmer MP, The JJ, et al. Pharmacological non-hormonal treatment options for male infertility: a systematic review and network meta-analysis. BMC Urol. 2024;24(1):158 doi: 10.1186\/s12894-024-01545-1.","DOI":"10.1186\/s12894-024-01545-1"},{"key":"ref21","doi-asserted-by":"crossref","unstructured":"22. Ramasamy R, Scovell JM, Kovac JR, Lipshultz LI. Testosterone supplementation versus clomiphene citrate for hypogonadism: an age matched comparison of satisfaction and efficacy. J Urol. 2014; 192(3):875-9 doi: 10.1016\/j.juro.2014.03.089.","DOI":"10.1016\/j.juro.2014.03.089"},{"key":"ref22","doi-asserted-by":"crossref","unstructured":"23. Wheeler KK, Smith RP, Kumar RA, et al. A Comparison of Secondary Polycythemia in Hypogonadal Men Treated with Clomiphene Citrate versus Testosterone Replacement: A Multi-Institutional Study. J Urol. 2017;197(4):1127-1131 doi: 10.1016\/j.juro.2016.10.068.","DOI":"10.1016\/j.juro.2016.10.068"},{"key":"ref23","doi-asserted-by":"crossref","unstructured":"24. Wang C, Li P, Li Z. Clinical application of aromatase inhibitors to treat male infertility. Hum Reprod Update. 2021;28(1):30-50 doi: 10.1093\/humupd\/dmab036.","DOI":"10.1093\/humupd\/dmab036"},{"key":"ref24","doi-asserted-by":"crossref","unstructured":"25. Shah T, Nyirenda T, Shin D. Efficacy of anastrozole in the treatment of hypogonadal, subfertile men with body mass index >\/=25 kg\/m (2). Transl Androl Urol. 2021;10(3):1222-1228 doi: 10.21037\/tau-20-919.","DOI":"10.21037\/tau-20-919"},{"key":"ref25","doi-asserted-by":"crossref","unstructured":"26. Colleluori G, Chen R, Turin CG, et al. Aromatase Inhibitors Plus Weight Loss Improves the Hormonal Profile of Obese Hypogonadal Men Without Causing Major Side Effects. Front Endocrinol (Lausanne). 202; 11: 277 doi: 10.3389\/fendo.2020.00277.","DOI":"10.3389\/fendo.2020.00277"},{"key":"ref26","doi-asserted-by":"crossref","unstructured":"27. Del Giudice F, Busetto G.M, De Berardinis D, et al. A systematic review and meta-analysis of clinical trials implementing aromatase inhibitors to treat male infertility. Asian J Androl. 2020;22(4):360-367 doi: 10.4103\/aja.aja_101_19.","DOI":"10.4103\/aja.aja_101_19"},{"key":"ref27","doi-asserted-by":"crossref","unstructured":"28. Jones TH, Dobs AS, Randeva H, et al. Leflutrozole in male obesity-associated hypogonadotropic hypogonadism: Ph 2b double-blind randomized controlled trial. Eur J Endocrinol. 2023;189(3):297-308 doi: 10.1093\/ejendo\/lvad099.","DOI":"10.1093\/ejendo\/lvad099"},{"key":"ref28","doi-asserted-by":"crossref","unstructured":"29. Dutta D, Mohindra R, Kumar M, Sharma M. Role of Aromatase Inhibitors in Managing Hypogonadism in Adult Males Related to Obesity and Aging: A Systematic Review and Meta-Analysis. Indian J Endocrinol Metab. 2022;26(6):501-509. doi: 10.4103\/ijem.ijem_3_22.","DOI":"10.4103\/ijem.ijem_3_22"}],"container-title":["Polski Merkuriusz Lekarski"],"original-title":[],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T20:00:34Z","timestamp":1777406434000},"score":1,"resource":{"primary":{"URL":"https:\/\/polskimerkuriuszlekarski.pl\/wp-content\/uploads\/library\/PolMerkurLek20026i2net.pdf"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,1]]},"references-count":29,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,4,1]]},"published-print":{"date-parts":[[2026,4,1]]}},"URL":"https:\/\/doi.org\/10.36740\/merkur202602119","relation":{},"ISSN":["1426-9686"],"issn-type":[{"value":"1426-9686","type":"print"}],"subject":[],"published":{"date-parts":[[2026,4,1]]}}}