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Background Partial androgen deficiency syndrome in the aging male is associated with signs of aging such as a development of abdominal obesity,sexual dysfunction,increase body fat,weight gain and the development of cardiac disease.Objective We assessed the outcome of a commercially available physician supervised nutrition and exercise program with concomitant testosterone replacement therapy in middle age obese men with partial androgen deficiency in order to reduce cardiac risks factors.Methods Fifty-six self referred men without diabetes mellitus,hypertension,or cardiovascular disease (ages 52.3 ± 7.8 years) were randomly selected from a large cohort.Baseline weight,body fat composition,fasting glucose,hemoglobin Alc and fasting lipid levels,as well as free and total testosterone levels were assessed.All patients were assessed and followed 6-18 months after initiation of the program.The program consisted of a low glycemic load balanced nutrition diet,a recommended structured daily exercise program of 30-60 minutes,as well as once to twice weekly intramuscular testosterone injections (113.0 ± 27.8 mg).Results At follow up,weight was reduced from 233.9 ± 30.0 pounds (lbs) to 221.3 ± 25.1 lbs (P ＜ 0.001),BMI was reduced from 33.2 ± 3.3 kg/m2 to 31.3 ± 2.8 kg/m2 (P ＜ 0.0001).Total body fat was 27.1％ ± 5.2％ vs.34.3％ ± 5.7％ at baseline (P ＜ 0.0001).Fasting glucose was reduced from 95.3 ± 14.4 mg/dL to 87.5 ± 12.6 mg/dL (P ＜ 0.0001).Total cholesterol was reduced from 195.4 ± 33.0 mg/dL to 172.7 ± 35.0 mg/dL (P ＜ 0.005).No clinically significant adverse events were recorded.Conclusions Testosterone replacement therapy in middle aged obese men with partial androgen deficiency appeared safe and might have promoted the effects of a weight reduction diet and daily exercise program as long as an adequate physician supervision and follow up was granted.The combination therapy significantly reduced coronary risk factors such as glucose intolerance and hyperlipidemia.