目的 探讨司美格鲁肽对男性肥胖相关继发性性腺功能减退（MOSH）及单纯性肥胖患者性腺功能的影响差异。 方法 纳入37例肥胖［体质量指数（BMI）≥ 28 kg/m2且腹围> 90 cm］男性患者，根据总睾酮水平分为MOSH组与单纯性肥胖组。所有患者接受为期24周的司美格鲁肽干预。比较两组治疗前后国际勃起功能指数-5（IIEF-5）评分、性激素水平及精液参数的变化。 结果 治疗后，两组患者的BMI、腹围及内脏脂肪面积均较基线显著下降。MOSH组患者IIEF-5评分、总睾酮水平及前向运动精子比例均显著升高（P < 0.05），而卵泡刺激素（FSH）与黄体生成素（LH）水平无明显变化（P > 0.05）。相关性分析显示，MOSH组总睾酮升高幅度与内脏脂肪面积减少幅度呈显著正相关（r = 0.406，P = 0.013）。单纯性肥胖组仅LH水平较治疗前下降（P < 0.05），其余性腺功能及精液参数均无明显变化（P > 0.05）。多重线性回归结果显示基线总睾酮基线水平是治疗后总睾酮变化水平的影响因素。 结论 司美格鲁肽可有效改善MOSH患者的性腺功能及精子质量，但对不伴性腺功能减退的单纯性肥胖男性患者性腺轴影响有限。司美格鲁肽有望成为MOSH患者的潜在治疗选择。

Objective To investigate the differential effects of semaglutide on gonadal function between men with male obesity-associated secondary hypogonadism （MOSH） and those with simple obesity. Methods A total of 37 obese male patients， with a body mass index （BMI） of 28 kg/m2 or higher and a waist circumference exceeding 90 cm， were recruited and divided into the MOSH group and the simple obesity group based on their baseline total testosterone levels. All patients underwent a 24-week intervention with semaglutide. The changes in the International Index of Erectile Function-5 （IIEF-5） score， sex hormone levels， and semen parameters were compared between the two groups both before and after treatment. Results After treatment， the BMI， waist circumference， and visceral fat area in both groups were significantly reduced compared to the baseline values. In the MOSH group， the IIEF-5 score， total testosterone level， and progressive sperm motility all showed significant increases （all P < 0.05）. Meanwhile， no significant alterations were detected in the follicle-stimulating hormone （FSH） or luteinizing hormone （LH） levels （both P > 0.05）. Correlation analysis indicated that in the MOSH group， the increase in total testosterone was significantly and positively correlated with the reduction in visceral fat area （r = 0.406， P = 0.013）. In the simple obesity group， only the LH level decreased significantly after treatment （P < 0.05）， and there were no significant changes in other gonadal function indicators or semen parameters （all P > 0.05）. Multiple linear regression analysis demonstrated that the baseline total testosterone level was an influencing factor for the change in total testosterone after treatment. Conclusions Semaglutide effectively enhances gonadal function and sperm quality in patients with MOSH. However， it has limited impacts on the hypothalamic-pituitary-gonadal axis in men with simple obesity without hypogonadism. Semaglutide can potentially be a therapeutic option for patients with MOSH.