Androgens and Adipose Tissue in Males: A Complex and Reciprocal Interplay
Reciprocal interplay between white adipose tissue (WAT) and testis. (a) In normal conditions, circulating androgens control adipocyte size and adipose mass. On the other hand, plasmatic leptin, mainly produced by adipose tissue, regulate testicular steroidogenesis. Dashed bars indicate the reciprocal interplay between testis (through androgens) and adipose tissue (mainly through leptin). (b) Androgen deficiency induces expansion of fat mass and subsequent dysregulation of several functions controlled by adipose tissue such as insulin sensitivity, blood pressure, vascular reactivity, and immunity. The state of insulin resistance determined by obesity leads to reduced production of SHBG. The consequent reduction in testosterone triggers expansion of adipose mass with subsequent increase in aromatase (ARO) activity, which in turn mediates peripheral conversion of testosterone to estradiol. Increased estrogen levels induce a reduction of LH pulse which contributes to the reduction in androgen production. On the other hand, excess of circulating leptin, due to increased adipose mass, disrupts testicular steroidogenesis, with consequent suppression of androgen production. The vicious cycle is triggered. AR: androgen receptor.