Weight Loss Threshold and Inflection Points for Biochemical Remission of Male Obesity-Associated Secondary Hypogonadism After Sleeve Gastrectomy
In brief
Losing 22% of weight after sleeve gastrectomy yields 90% hormone remission
In 230 men with obesity-related secondary hypogonadism, a 21.8% total weight loss after sleeve gastrectomy was the exploratory lower limit that raised remission to about 90%, and further loss up to 36% did not add benefit. Age, baseline BMI and diabetes did not change this pattern, but prospective studies are needed before using these thresholds in practice.
- Journal
- Obesity surgery (Q1)
- Published
- 31 August 2026
- Study design
- Prospective / inception cohort
- Evidence level
- Level 2, Moderate (CEBM 2b)
- Authors
- Yian Zhao, Chong Cao, Rong Hua, Yuxiao Chu, Xiaozhuo Tan, Mengcheng He, et al.
- PMID
- 42671498
- DOI
- 10.1007/s11695-026-08923-8
Why clinicians should know about it
- Picked for Bariatric and Metabolic Surgery (paper of the day, 2 September 2026): Weight‑loss thresholds after sleeve gastrectomy
Abstract
INTRODUCTION: Male obesity-associated secondary hypogonadism (MOSH) is common in men with obesity and can improve following metabolic bariatric surgery (MBS). However, the quantitative relationship between postoperative weight loss and biochemical remission of MOSH remains unclear. This study aimed to characterize the nonlinear association between percentage total weight loss (TWL%) and MOSH remission after laparoscopic sleeve gastrectomy (LSG), and to identify clinically relevant weight-loss thresholds. METHODS: This retrospective study included MOSH patients undergoing LSG with one-year follow-up. Restricted cubic spline (RCS) modeling evaluated the nonlinear relationship between TWL% and remission. Patients were grouped by RCS-derived thresholds, and logistic regression with interaction analyses examined the association and effect modification. RESULTS: Among 230 patients, mean TWL% was 31.60% and remission rate was 82.17% at one year after LSG. RCS revealed a nonlinear association (P = 0.041) with an exploratory effect-initiation threshold at 21.8% TWL% and a suggested plateau period at 36.0% TWL%. Corresponding remission rates were 47.1% (< 21.8% TWL%), 88.9% (21.8-36.0% TWL%), and 87.1% (≥ 36.0% TWL%). Both higher TWL% groups had significantly greater odds of remission compared with the lowest group (adjusted odds ratio [aOR]: 10.61 and 10.64, respectively). Age, preoperative body mass index (BMI), and type 2 diabetes mellitus (T2DM) did not modify the relationship. CONCLUSION: Achieving 21.8% TWL% may represent an exploratory lower threshold for high remission probability, while 36.0% TWL% may indicate the onset of a plateau period. These findings provide preliminary reference points that require prospective validation before being considered for clinical guidance. KEY POINTS: • 21.8% TWL% may represent an exploratory minimum threshold for high MOSH remission probability after LSG. • 36.0% TWL% may indicate a plateau; further weight loss appears to yield no additional remission benefit. • These exploratory thresholds showed consistency across age, preoperative BMI, and T2DM subgroups in this cohort.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.