SAT-167 - Dose-Response Effects of Aerobic Exercise Intensity on Testosterone Levels in Overweight and Obese Men: A Systematic Review and Meta-Analysis

Background: Obesity is associated with reduced testosterone levels in men, contributing to metabolic dysfunction, diminished vitality, and impaired reproductive health. Although aerobic exercise is widely recommended for improving metabolic and hormonal profiles, the optimal exercise intensity required to maximize testosterone responses in overweight and obese men remains insufficiently defined. Clarifying this relationship may guide more targeted exercise prescriptions aimed at hormonal restoration. We aimed to evaluate the dose response relationship between aerobic exercise intensity and serum testosterone in overweight/obese men.

Methods: This systematic review and meta-analysis was prospectively registered (PROSPERO: CRD420261283326) and conducted following PRISMA guidelines. PubMed, Scopus, and Web of Science were searched through January 2025 for randomized controlled trials and controlled trials examining structured aerobic exercise interventions (≥8 weeks) on testosterone in overweight/obese men (BMI ≥25 kg/m²). Eligible comparators included control groups, alternative exercise intensities, or diet-only interventions. Effect sizes (Cohen's d) were calculated from reported means and standard deviations. Meta-analysis was performed using a random-effects model in RevMan Web (Cochrane). Risk of bias was assessed using the Cochrane RoB 2 tool.

Results: Five studies (4 RCTs, 1 controlled trial) comprising 202 overweight/obese men (mean BMI: 25.7–30.5 kg/m²; age range: 30–65 years) with intervention durations of 8–24 weeks were included. Aerobic exercise produced a significant increase in testosterone (pooled Cohen's d = 2.07, 95% CI [0.78, 3.37], p = 0.002). Substantial heterogeneity was observed (I² = 93.0%, Q = 56.80, p < 0.001), attributable to differences in exercise intensity. Subgroup analysis revealed an intensity-dependent response: moderate intensity (1 study, n = 75; d = 0.45, 95% CI [−0.01, 0.91]), moderate-vigorous intensity (2 studies, n = 69; d = 0.47–4.20), and high-intensity interval training (HIIT) (2 studies, n = 58; d = 1.89–4.32). HIIT demonstrated the largest effects, with testosterone increases of +29–37% within 8–12 weeks. Most studies had low to moderate risk of bias.

Conclusions: Aerobic exercise significantly increases testosterone in overweight/obese men, with a dose-response relationship favoring higher intensities. HIIT appears most effective for testosterone optimization in this population. Given the limited number of studies and considerable heterogeneity, further research, particularly large randomized controlled trials with standardized exercise protocols, is needed to establish optimal exercise prescriptions for testosterone enhancement in men with obesity.

*Unless otherwise noted, all abstracts presented at ENDO must not be released to the press or the public until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.*