Exercise Self-Efficacy, Body Composition, and Physical Activity in Men With Hypogonadism

November 6, 2026 updated by: Aybüke Fanuscu, Hacettepe University

The Mediating Role of Exercise Self-Efficacy in the Relationship Between Body Composition and Physical Activity in Men With Hypogonadism: A Cross-Sectional Study

Male hypogonadism is a chronic endocrine condition characterized by deficient testosterone production, leading to adverse changes in body composition (decreased lean mass, increased fat mass) and various physical and psychological symptoms, including fatigue and reduced motivation. Although testosterone replacement therapy (TRT) is the primary medical treatment, its effectiveness in optimizing body composition largely depends on regular physical activity. However, the psychosocial mechanisms underlying exercise engagement in this specific population remain insufficiently explored.

Exercise self-efficacy, an individual's confidence in their ability to perform physical activity, is a major determinant of exercise behavior. While its mediating role between body composition and physical activity has been shown in other clinical populations, it has not been investigated in men with hypogonadism, where low testosterone levels uniquely impair psychological well-being and drive.

The primary objective of this cross-sectional study is to evaluate the mediating role of exercise self-efficacy in the relationship between body composition and physical activity levels in men with hypogonadism receiving TRT. Additionally, the study explores the potential moderating effects of serum total testosterone levels and TRT duration, while controlling for depressive symptoms as a covariate. Findings from this study aim to provide evidence-based guidance for clinicians and physical therapists in designing targeted exercise interventions and timing rehabilitation strategies for hypogonadal patients.

Study Overview

Status

Recruiting

Conditions

Detailed Description

Male hypogonadism is associated with adverse alterations in body composition, including reduced lean muscle mass and increased adiposity, alongside symptoms such as fatigue, dysphoric mood, and reduced motivation. Although testosterone replacement therapy (TRT) serves as the primary medical intervention, optimizing body composition outcomes relies significantly on concurrent physical activity.

Exercise self-efficacy, the confidence in one's capability to carry out physical activity, is a robust determinant of exercise adherence. In hypogonadism, low testosterone levels uniquely impair psychosocial well-being and motivational drive, creating a distinct biologically driven barrier to exercise engagement that differs from general metabolic or obesity-related populations.

Furthermore, the physiological and psychological responses to TRT follow a time-dependent trajectory. Early stages of therapy may exhibit rapid shifts in mood and sociability, whereas energy levels and physical capacity gradually improve over subsequent weeks and months. This temporal progression suggests that TRT duration and serum total testosterone levels may serve as critical moderators influencing how body composition interacts with exercise self-efficacy and physical activity.

This study evaluates the structural relationships between body composition parameters and physical activity levels in men with hypogonadism. Specifically, it tests whether exercise self-efficacy mediates this relationship, and assesses the potential moderating roles of serum total testosterone levels and TRT duration, while statistically controlling for depressive symptoms to isolate the specific biological and psychosocial pathways.

Study Type

Observational

Enrollment (Estimated)

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Name: Emine Şener Aydın, MD
Phone Number: +904222118019
Email: dreminesener@windowslive.com

Study Locations

Turkey (Türkiye)
- - Bingoel, Turkey (Türkiye)
    - Recruiting
    - Bingol University Faculty of Physical Therapy and Rehabilitation
    - Contact:
      
      Aybüke Fanuscu, Pt, PhD
      
      Phone Number: 5548 +904262160012
      
      Email: afanuscu@bingol.edu.tr
  - Malatya, Turkey (Türkiye)
    - Recruiting
    - Malatya Training and Research Hospital
    - Contact:
      
      Emine Şener Aydın, MD
      
      Email: dreminesener@windowslive.com

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years and older (Adult, Older Adult)

Accepts Healthy Volunteers

Genders Eligible for Study

Male

Sampling Method

Non-Probability Sample

Study Population

The study population consists of adult male patients aged 18 years or older who have been diagnosed with primary or secondary hypogonadism (biochemically confirmed morning serum total testosterone <300 ng/dL) and are currently receiving testosterone replacement therapy (TRT). Participants will be recruited from patients attending routine clinical visits at the Endocrinology Outpatient Clinic of Malatya Training and Research Hospital.

Description

Inclusion Criteria:

Confirmed diagnosis of male hypogonadism (primary or secondary; biochemically verified with a morning serum total testosterone level <300 ng/dL).
Currently undergoing TRT with observed partial or complete symptom remission, evaluated as treatment-responsive by the clinician.
Aged 18 years or older.
Ability to read and write in Turkish.
Voluntary agreement to participate and signature on the informed consent form.

Exclusion Criteria:

Neurological, orthopedic, or cardiopulmonary conditions independent of hypogonadism that restrict physical activity capacity.
Diagnosed psychiatric disorders directly impacting exercise self-efficacy and physical activity (e.g., major depressive disorder, psychosis).
Concomitant endocrine disorders significantly affecting body composition, including uncontrolled or complicated diabetes mellitus (HbA1c >8.0% or presence of diabetic nephropathy, neuropathy, retinopathy) or biochemically unverified euthyroid state in thyroid disease.
Presence of conditions preventing bioelectrical impedance analysis (e.g., implanted cardiac devices/pacemakers).
Visual or cognitive impairments preventing the reading and completion of study questionnaires.
Chronic inflammatory conditions directly affecting body composition and physical capacity (e.g., chronic kidney disease, inflammatory bowel disease, rheumatoid arthritis, systemic lupus erythematosus, ankylosing spondylitis).

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

Observational Models: OTHER
Time Perspectives: PROSPECTIVE

Number of groups / cohorts

Cohorts and Interventions

Group / Cohort
Men with Hypogonadism on TRT Male patients aged 18 years or older who have been diagnosed with primary or secondary hypogonadism (biochemically verified morning serum total testosterone <300 ng/dL) and are currently receiving testosterone replacement therapy (TRT).

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Physical Activity Level Time Frame: Baseline	Assessed using the International Physical Activity Questionnaire - Short Form (IPAQ-SF). IPAQ-SF evaluates walking, moderate, and vigorous intensity physical activities performed over the last 7 days. Total physical activity score will be calculated as MET-minutes/week.	Baseline

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Exercise Self-Efficacy Score Time Frame: Baseline	Evaluated via the Exercise Self-Efficacy Scale (EXSE). The scale consists of 18 items assessing an individual's confidence to maintain exercise across challenging situations. Items are rated on a 0-100 numerical rating scale with 10-unit intervals. Total scores range from 0 to 1800, with higher scores reflecting greater confidence in exercise adherence.	Baseline
Body Weight Time Frame: Baseline	Measured using a Tanita BC-420SMA Bioelectrical Impedance Analyzer. This outcome reports body weight in kilograms.	Baseline
Serum Total Testosterone Level Time Frame: Baseline	Recorded from recent morning routine clinical laboratory records. Measured in nanograms per deciliter (ng/dL).	Baseline
Depressive Symptoms (Covariate) Time Frame: Baseline	Evaluated using the depression subscale of the Hospital Anxiety and Depression Scale (HADS-D). Contains 7 items, each scored on a 0-3 Likert scale (subscale score ranges from 0 to 21), with higher scores indicating higher levels of depressive symptoms.	Baseline
Body Mass Index (BMI) Time Frame: Baseline	Calculated using height and body weight via a Tanita BC-420SMA Bioelectrical Impedance Analyzer.	Baseline

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Hacettepe University

Investigators

Principal Investigator: Aybüke Fanuscu, Pt, PhD, Bingol University

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

October 20, 2026

Primary Completion (Estimated)

September 30, 2027

Study Completion (Estimated)

October 15, 2027

Study Registration Dates

First Submitted

August 4, 2026

First Submitted That Met QC Criteria

November 6, 2026

First Posted (Actual)

November 9, 2026

Study Record Updates

Last Update Posted (Actual)