Men are typically more prone to storing fat viscerally (around the abdomen), while women typically store fat subcutaneously (around the hips and thighs).
A 2019 hypothesis paper published in Frontiers in Physiology offers a compelling mechanistic explanation: men produce larger and more chylomicrons—fat-transporting particles made in the gut after eating. These oversized chylomicrons congest the intestinal lymphatics and are more likely to get trapped in the abdominal region. Once trapped, they are broken down by lipoprotein lipase, and the released fatty acids are preferentially stored in nearby visceral fat depots such as the mesentery and omentum [1].
In other words, men’s gut physiology and hormonal profiles make them more prone to visceral fat accumulation, which in turn feeds back to reduce testosterone levels—amplifying metabolic risk.
A 2023 study of 1,551 men found that those in the highest quartile of Visceral Adiposity Index (VAI) were 5 times more likely to have testosterone deficiency compared to those in the lowest quartile (OR = 5.07, p < 0.0001) [2]. The study also showed that as VAI increased, total testosterone levels significantly decreased, independent of age, BMI, and other confounders.
References
[1] Nauli & Matin (2019). Why Do Men Accumulate Abdominal Visceral Fat? Front Physiol, 10:1486. https://www.frontiersin.org/articles/10.3389/fphys.2019.01486/full
[2] Su et al. (2023). The Impact of Visceral Adiposity on Testosterone Levels in American Adult Men. Med Sci Monit, 29: e941394. https://www.medscimonit.com/abstract/index/idArt/941394