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In men , severe calorie restriction similarly affects the hypothalamic-pituitary-testicular axis: Decreased testosterone production: Both total and free testosterone levels may decline, directly reducing libido and erectile function Increased sex hormone-binding globulin (SHBG): Further reducing bioavailable testosterone Reduced sperm production: May occur in severe or prolonged energy deficits, reflecting overall suppression of reproductive capacity Conversely, moderate weight loss in men with overweight or obesity often increases testosterone levels and improves erectile function

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The total sample size is approximately 38,400 participants

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