Dietary Interventions and Testosterone Levels in Obese Men: A Systematic Review Comparing the Mediterranean Diet, Ketogenic Diet, and Intermittent Fasting
Abstract
Background/objectives: Male obesity secondary hypogonadism (MOSH) is a highly prevalent condition characterised by reduced testosterone levels in obese men, driven by increased aromatase activity, reduced SHBG, insulin resistance, and HPG axis suppression. Dietary interventions represent a cornerstone of non-pharmacological management; however, the comparative efficacy of different dietary patterns on testosterone restoration remains unclear.
Methods: We conducted a systematic literature review following PRISMA 2020 guidelines. Comprehensive searches were performed in SciSpace, Google Scholar, and PubMed through June 2026. Eligible studies included human adult males with obesity (BMI ≥ 30 kg/m2) undergoing Mediterranean diet (MedDiet), ketogenic diet (KD/VLCKD), or intermittent fasting (IF) interventions, with quantitative assessment of testosterone or androgen status.
Results: From 697 initial records, 500 unique papers were identified after deduplication. Following abstract screening (n = 442 excluded) and full-text assessment (n = 6 excluded), 52 studies were included in the final synthesis. VLCKD demonstrated the most consistent evidence for testosterone improvement, with RCTs reporting significant increases in total testosterone (+1.5 to +3.0 nmol/L). Intermittent fasting showed promising but more heterogeneous results. Evidence for Mediterranean diet was limited, focusing primarily on metabolic rather than hormonal outcomes. Weight loss emerged as a critical mediator…
How strong is the evidence?
Evidence Hub reads this as a systematic review, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 442 participants or records.
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