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Message: <blockquote data-quote="Celsus" data-source="post: 865746" data-attributes="member: 185674">Continued...  3/3.Interaction between adipose tissue, testosterone and insulin resistance. The enzyme aromatase, present in high concentrations in adipose tissue, converts testosterone to oestrogen. Increasing abdominal fat leads to an increased aromatase activity. The resulting low testosterone increases lipoprotein lipase activity and triglyceride uptake leading to an increased visceral adiposity and insulin resistance. This in turn causes further hypogonadism and abdominal fat deposition. Furthermore, with increasing visceral fat, LH pulse amplitude is reduced, probably through the action of certain factors such as leptin at the pituitary level, leading to further reduction in testosterone levels.Cohen<a href="http://www.diabetes.co.uk/forum/javascript:newshowcontent('active','references');" target="_blank">[66]</a> has described the hypogonadal–obesity cycle. During the hypogonadal state, there is an increase in deposition of abdominal adipose tissue. This Results in increased aromatase activity leading to a greater formation of oestradiol from testosterone. This will then lead to a further reduction in serum and tissue testosterone concentrations, increased deposition of abdominal fat and progressive hypogonadism.Leptin is the adipocyte-secreted protein product of the ob gene. It is strongly linked to obesity and regulates weight and adipose tissue mass. Serum leptin levels correlate positively with age, BMI, serum insulin and fat mass and inversely with testosterone.<a href="http://www.diabetes.co.uk/forum/javascript:newshowcontent('active','references');" target="_blank">[67]</a> Leptin levels are higher in ageing males with lower testosterone and testosterone replacement therapy corrects this. The mechanism is unclear but is likely to be related to a combination of reduction in adipose tissue mass and a direct suppressive effect on ob gene expression.<a href="http://www.diabetes.co.uk/forum/javascript:newshowcontent('active','references');" target="_blank">[68]</a> As total body fat mass increases with low testosterone, hormone resistance develops for leptin and insulin. Increasing leptin fails to prevent weight gain and the hypogonadal–obesity cycle ensues, causing further visceral obesity and insulin resistance.<a href="http://www.diabetes.co.uk/forum/javascript:newshowcontent('active','references');" target="_blank">[69]</a> Although the mechanisms responsible for the hypogonadism in obesity are varied, testosterone therapy in obese men reduces visceral fat mass.<a href="http://www.diabetes.co.uk/forum/javascript:newshowcontent('active','references');" target="_blank">[70]</a> In elderly men, studies have demonstrated that testosterone decreases body fat mass and increases the lean mass. There is a variability in the responsiveness of the body fat to testosterone administration that depends on the duration of therapy, although other factors such as pretreatment body composition and the age of the subjects also play a role.<a href="http://www.diabetes.co.uk/forum/javascript:newshowcontent('active','references');" target="_blank">[69]</a></blockquote>

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