MOSH syndrome – a new vizion of secondary hypogonadism

Functional male hypogonadism in association with obesity has recently been defined as secondary obesity-induced hypogonadism – MOSH syndrome. Сlinical manifestations are explained by two important mechanisms: testosterone deficiency and excess adipose tissue. Synthesis of 50 articles predominantly of the last 10 years from databases: Google Scholar, PubMed, Research Gate, Wiley Online Library, Health Data Science using keywords – „MOSH”, „hypogonadism”, „obesity”, „male sex-reproductive dysfunction”, „infertility”. The prevalence of MOSH in the general population is 45% and correlates positively with the degree of obesity. Multifactorial pathogenetic mechanisms include lipotoxicity, suppression of the hypothalamic-pituitary-gonadal axis, leptinresistance, hyperestrogenemia, oxidative stress, proinflammatory status, metabolic insulinoresistance and endotoxemia, sleep apnea, genetic and epigenetic changes, etc, with major impact on male sexual-reproductive health. Treatment strategy includes decrease in body mass, which can relieve the symptoms of androgen deficiency, improve metabolic profile and fertility. MOSH is a subtype of functional hypogonadism with reversible potential with substantial weight loss.