ometendoОжирение и метаболизмObesity and metabolism2071-87132306-5524Endocrinology Research Centre10.14341/omet10314ometendo-10314Research ArticleОбзор литературыReviewМужское здоровье и ожирение – диагностика и терапевтические подходыMale health and obesity – diagnostic and therapeutic approachhttps://orcid.org/0000-0002-9128-2714ГамидовСафар ИсраиловичGamidovSafar I.

д.м.н.

MD, PhD

safargamidov@yandex.ruhttps://orcid.org/0000-0002-3902-9236ШатылкоТарас ВалерьевичShatylkoTaras V.

к.м.н.

MD, PhD

dialectic.law@gmail.comhttps://orcid.org/0000-0003-4695-9789ГасановНатиг ГасановичGasanovNatig G.

MD

natiqhasan@gmail.comФГБУ «Научный центр акушерства, гинекологии и перинатологии им. академика В.И. Кулакова» Министерства здравоохранения Российской Федерации; ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Министерства здравоохранения Российской Федерации (Сеченовский Университет)РоссияAcademician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology and Perinatology; I.M. Sechenov First Moscow State Medical University (Sechenov University)Russian FederationФГБУ «Научный центр акушерства, гинекологии и перинатологии им. академика В.И. Кулакова» Министерства здравоохранения Российской ФедерацииРоссияAcademician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology and PerinatologyRussian Federation2019211220191632936Copyright © Гамидов С.И., Шатылко Т.В., Гасанов Н.Г., 20192019Гамидов С.И., Шатылко Т.В., Гасанов Н.Г.Gamidov S.I., Shatylko T.V., Gasanov N.G.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.omet-endojournals.ru/jour/article/view/10314

Ожирение может представлять собой значительную медицинскую проблему для любого человека, независимо от возраста или пола. У мужчин ожирение вызывает существенный психологический стресс, сексуальную дисфункцию, субфертильность, гипогонадизм и сердечно-сосудистую патологию. Эти проблемы могут формировать между собой многочисленные патогенетические взаимосвязи по типу порочного круга. Основными факторами, неблагоприятно влияющими на мужскую фертильность и сексуальную функцию при ожирении и метаболическом синдроме, являются дисбаланс половых гормонов и системное воспаление. Многим пациентам необходимо назначать симптоматическую терапию по поводу вышеуказанных проявлений, но всегда целесообразно воздействовать на их патогенез и рекомендовать снижение массы тела с помощью модификации диеты и образа жизни. При невозможности соблюдения рекомендаций или отсутствии эффективности поведенческой терапии возможно применение лекарственных препаратов центрального и периферического действия, в частности орлистата, сибутрамина, лираглутида. При высоком индексе массы тела и неэффективности консервативной терапии пациентам следует предлагать бариатрическую хирургию. Без устранения избыточной массы тела решение проблем с сексуальной дисфункцией, гипогонадизмом и субфертильностью у мужчин с ожирением затруднительно. Все данные аспекты и доступные методы фармакологической терапии описаны в этой обзорной статье.

Obesity may present as a significant medical problem for any person, regardless of age or gender. In men obesity causes considerable psychological stress, sexual dysfunction, subfertility, hypogonadism and cardiovascular conditions. These problems may form numerous pathological associations between each other, creating a vicious circle. The main factors which influence male fertility and sexual function in obesity and metabolic syndrome are imbalance of sex hormones and systemic inflammation. In many patients symptomatic treatment is necessary for above-mentioned manifestations, but it is always rational to act on their pathophysiology and to recommend to lower the body mass by diet and lifestyle modification. When it proves impossible for the patient to follow such recommendations and when behavioral approach fails, central-acting and peripheral-acting medications may be used, including orlistat, sibutramine and liraglutide. Bariatric surgery should be offered to patients with high body mass index in whom conservative management fails. Without elimination of excess body mass it is difficult to solve problems regarding sexual dysfunction, hypogonadism and subfertility in obese males. All these issues and available modes of pharmacological treatment are described in this review.

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The authors declare that there are no conflicts of interest present.