Metabolically healthy and unhealthy obesity in erectile dysfunction and male infertility

ABSTRACT

Introduction: Metabolically unhealthy obesity (MUHO) is the most important preventable cardiovascular (CV) risk factor. Recently, the significance of metabolically healthy obesity (MHO) as a CV risk factor has raised increasing interest. MUHO is a known risk factor for erectile dysfunction (ED); however, the effect of MHO on ED has barely been investigated. This review aims at summarizing the evidence supporting the relation of MUHO and MHO to male sexual functioning and fertility.

Areas covered: An extensive Medline search on obesity and ED or male infertility was conducted to summarize the role of MUHO or MHO on male sexual dysfunction and infertility.

Expert opinion: Longitudinal studies have demonstrated that MHO causes vascular damage, which is consistent with the impairment in penile blood flows found in ED subjects. In this population, MHO is a predictor of CV events. The relationship between male infertility and MUHO is currently debated and data on MHO are almost completely lacking. The only available study did not find an association between obesity classes and semen parameters. Although the andrological correlates of MHO must be better assessed, in the current state, evidence suggests that MHO does not represent a benign condition and measures for improving lifestyle are mandatory.

KEYWORDS:

• Obesity
• healthy obesity
• erectile dysfunction
• vascular impairment
• fertility
• semen parameters

Article highlights

• Metabolically unhealthy obesity (MUHO) represents one of the most important preventable cardiovascular (CV) risk factors and a worldwide emerging public health issue.

• In recent years, the role of metabolically heathy obesity (MHO) as a CV risk factor has raised increasing interest. Longitudinal evidence has demonstrated that this condition predisposes patients to metabolic complications in at least 30% of cases and it is associated with higher CV risk when compared to normal weight.

• Erectile dysfunction (ED) is considered an early marker of forthcoming CV risk, particularly in subjects commonly deemed at low risk, such as younger men.

• MUHO is a risk factor for ED. Only few studies have investigated the contribution of MHO to erectile function and their results suggest that MHO can induce preclinical vascular damage, as assessed by the penile vascular flow. In addition, ED men with MHO are at higher risk for forthcoming major adverse CV events.

• The combination of ED and MHO could represent an early marker of forthcoming adverse metabolic consequences, so its recognition should induce clinicians to encourage patients to adopt healthy lifestyle strategies.

• Mounting evidence suggests that male infertility could be regarded as a possible marker of general male health.

• The impact of overweight and obesity on semen parameters is conflicting. The impact of BMI-associated complications has rarely been considered in the studies published so far.

• Only one study specifically evaluated the contribution of MUHO and MHO on semen parameters, without finding any association between obesity classes and semen parameters. Both MHO and MUHO were associated with a higher prostate volume, which was closely linked to the biochemical and ultrasound features of chronic inflammation only in MUHO.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Additional information

Funding

This paper was not funded.