Could Low Testosterone be Causing Weight Gain and Sluggishness

August 28, 2013 No Comments by Scott Isaacs, M.D.


Low testosterone can make it hard to maintain a healthy weight and feel energetic. St. Louis resident Roy Rehme, 45, now knows all about this.

Rehme felt sluggish for years. He was tipping the scale at 200 pounds, having put extra weight on his 5-foot-5-inch frame. “I was chronically tired,” said Rehme, who travels frequently for his job. “I would do my routine, work, and sleep.”

Between work, the extra weight, and fatigue, he didn’t have the energy to spend time with his wife of 13 years or their three sons.

Rehme’s primary care physician thought he might have low vitamin D levels. It was his orthopedist, Stephen Benz, MD, an orthopedic surgeon and founder of the Men’s Medical Institute in St. Louis, however, who remarked that Rehme didn’t seem like himself and should get tested for low T. Dr. Benz often sees patients with low T because low levels can lead to osteoporosis. A blood test found that Rehme did have low testosterone — in the 200s. The normal for a young man is 800 to 1,000 ng/dl; a testosterone level in the 200s is more like a reading for a man in his seventies or eighties.

“I knew nothing about low testosterone at that time,” said Rehme, who started on low T treatment with a cream specially formulated for him at Benz’s office. He rubs the cream every morning on his shoulder, arm, or thigh.

After three months of therapy, Rehme had turned around the weight gain and low T cycle. His energy level and health took positive turns. In fact, shortly after starting the low T therapy, he wanted to exercise again and eat healthy, and his healthier habits have led to a weight loss of nearly 30 pounds. He also now has the energy to do yard work and to spend quality time with his three sons.

Weight Gain and Low Testosterone: Pinpointing the Connection

Having low testosterone levels doesn’t necessarily make you gain weight, said Scott Isaacs, MD, an endocrinologist, faculty member of Emory University School of Medicine, medical director for Atlanta Endocrine Associates, and author of Hormonal Balance: How to Lose Weight by Understanding Your Hormones and Metabolism. However, when you gain weight, your testosterone levels will decrease. “Obesity is the number one cause of low testosterone,” Dr. Isaacs said. “Taking testosterone alone rarely results in weight loss. Most patients need to change their eating habits.”

What usually happens is that losing weight helps testosterone levels shoot back up to more normal levels, Isaacs added, or as in Rehme’s case, you feel more energetic once your treatment kicks in, so you return to the gym and feel motivated to eat a healthier diet. Some men who receive testosterone therapy develop increased muscle mass and appear more trim, even if their actual weight does not change.

What to Do About Weight Gain and Low T 

Take these steps to help regain your energy and be fitter:

Don’t feel embarrassed about getting tested for low T, said Benz. “Men shouldn’t be macho about taking care of their health,” he said. Having low testosterone is actually quite common.

Get a second opinion if you continue to feel fatigued or experience weight gain even after you’ve seen a physician. “Listen to your body,” said Rehme. Request blood tests for various health problems that may be contributing to your weight gain or lack of energy, including low T.

Make the decision to lose weight with a healthy diet and exercise. “I find that patients who take care of their weight gain by diet or exercise — as opposed to using long-term testosterone replacement — are typically more satisfied,” said Isaacs. “If you lose weight and improve your health, your testosterone will respond.”

By Vanessa Caceres
Medically reviewed by Niya Jones, MD, MPH

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