Dung presented at Tam Anh General Hospital, TP HCM, weighing 110 kg with a body mass index (BMI) of 38,1, indicating severe obesity. He also suffered from grade three fatty liver disease, gout, varicose veins, and metabolic disorders. Doctor of Internal Medicine Level I Pham Thi Thu Ha, Department of Endocrinology and Diabetes, reported that the patient's visceral fat level was 2,5 times the safe threshold, accompanied by dyslipidemia.

Test results revealed the patient's testosterone level was very low, at only 3,35 nmol/L (compared to a normal range of 8,64-29 nmol/L). His free testosterone was 6,02 pg/mL (normal range 9,5-40,6 pg/mL), indicating male hypogonadism alongside obesity and metabolic disorders.

Doctor Ha consults Dung on weight loss. *Photo: Tam Anh General Hospital*

According to Doctor Ha, obese men may experience decreased sexual desire, erectile dysfunction, and reduced sperm quality. Obesity causes metabolic disorders and a decline in hormones, including testosterone, a crucial male hormone. Increased fat tissue boosts the conversion of testosterone into estrogen (a female hormone), thereby lowering free testosterone levels.

Overweight and obese men face a higher risk of elevated cholesterol, high blood pressure, and type 2 diabetes. These factors all affect blood vessels and blood flow to the reproductive organs, which can cause erectile dysfunction.

Obesity also affects spermatogenesis due to endocrine disruption and increased oxidative stress, leading to reduced sperm density, motility, and normal morphology, which increases the risk of male infertility.

Dung undergoes an InBody measurement at Tam Anh General Hospital. *Photo: Hospital provided*

Doctor Ha designed a multi-modal, individualized weight loss regimen tailored to Dung's lifestyle and work conditions. In addition to appetite suppressants and blood sugar control medication, the patient received guidance on a flexible yet scientific and nutritious diet to aid weight loss. He was also advised to perform simple, easy-to-follow exercises for approximately 15-20 minutes daily.

After two months, he lost 8 kg, his blood sugar stabilized, and knee pain significantly decreased. He continues his treatment plan, aiming to reach 70 kg to better manage his musculoskeletal conditions and dyslipidemia.

Duc Hanh

*Patient's name has been changed