Reproductive System

Hormonal Complications: Males Obese men have elevated levels of plasma estrone and estradiol that correlate with the degree of obesity. Plasma total testosterone and free testosterone (the biologically active moiety) are reduced in obese men, and the reductions correlate negatively with the degree of obesity. The reduced levels of free and total testosterone are not generally accompanied by hypogo-nadism or a decrease in libido, potency, or sperm count in obese men. Free and total plasma testosterone levels normalize upon significant weight reduction. Also, estrogen levels are normalized if individuals attain normal weight but not if the weight loss is modest and significant obesity persists.

Hormonal Complications: Females Obese women have normal levels of total plasma estradiol but reduced levels of sex hormone binding globulins (SHBG). Thus, free estradiol (the biological active moiety) is significantly elevated. The high levels of free estradiol are postulated to increase the risks of endometrial and breast cancer and to reduce fertility. Estrone, derived in adipose tissue from androgen precursors, is also increased in obesity. Obesity in women is associated with the polycystic ovary syndrome (PCOS), characterized by hyper-estrogenism, hyperandrogenism, polycystic ovaries, oligomenorrhea or amenorrhea, hirsutism, and infertility. Women with PCOS also have insulin resistance and are at high risk for developing impaired glucose tolerance and diabetes mellitus. Weight loss usually normalizes SHBG and estradiol levels for individuals with simple obesity, but weight loss may not restore fertility to patients with severe PCOS.

Obstetric complications Obesity increases the risk of complications during pregnancy and child birth. Increased body weight, hypertension, and fluid retention during pregnancy can lead to toxemia of pregnancy. Heavier women have a longer duration of labor and a greater frequency of abnormal labor and caesarian sections.

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