Instead, they reduce total body weight which can have detrimental effects for older adults. Weight loss interventions cannot target just visceral fat. Visceral fat, however, is stored in the gut and has been linked to negative health impacts including diabetes and cardiovascular disease. Thus, a longer duration of HFD feeding and AI treatment (and greater fat gain) may be required to reveal differences in adipocyte size that reflect the elevated visceral fat in these animals. Finally, all potential covariates, including age, race, education, diabetes, hypertension, smoking, alcohol use, and BMI, were adjusted in model 2. Then, age, race, and educational level were adjusted in model 1. We applied a suitable sample weight of each participant from the complex multistage cluster survey design of NHANES . Borderline diabetes was diagnosed when participants had abnormal results of these glucose related tests less than the standard of diabetes. The BMI was calculated by dividing the weight (kg) by square of the height (m), rounding to the nearest 1/10 cm. Furthermore, the HOMA-IR was calculated as (fasting glucose mg/dl × fasting insulin μU/ml/405) . Then, all the participants aged younger than 20 years were also excluded from our study (4390). While weight loss is the primary and most effective treatment for high estrogen levels due to obesity, it may not always completely resolve the issue. As men age, their testosterone levels naturally decline, while their estrogen levels tend to remain relatively stable. Table 3 displays the subgroup analysis of the association between total testosterone level and VAI index. Men with a higher VAI index have a higher risk of declined testosterone level, or even testosterone deficiency, especially in aged men, or men without diabetes. Aromatization is the conversion of androgens, like testosterone, into estrogens, such as estradiol (E2). Compared to the TyG index derived from fasting glucose and triglyceride, the VAI index combines anthropometric indicators (BMI, WC) with lipid profiles, so we should not ignore use of the VAI index in predicting testosterone deficiency. Treatment with aromatase inhibitors may normalize the serum total testosterone in obese men . Firstly, most circulating estradiol is derived from testosterone via aromatase , and a substantial amount of aromatase located in visceral adipose tissue may ultimately catalyze the aromatization of testosterone into estradiol. If DHT was the major agonist of AR responsible for blocking adipogenesis, we would predict that reducing DHT levels in male mice would exacerbate HFD-induced adipogenesis. Enhanced adipocyte hyperplasia may also contribute to the increased fat mass observed in male hypogonadism. However, in male mice treated with AI, adipocyte size was only modestly elevated in visceral and subcutaneous fat (Figure 3K; Supp. Fig. 1F).
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