Diabetes & Low T: Treat Testosterone Deficiency?

Low testosterone is a common condition among men with diabetes—diabetic men are approximately twice as likely as others to develop low testosterone and hypogonadism. Because its symptoms mimic other conditions, patients often fail to report concerns and clinicians may fail to diagnose “Low T.” In recent years, Low T has received increasing attention and pharmacies across the nation are filling a rising number of testosterone prescriptions. Experts now describe diabetes as a fast-growing epidemic that creates a large healthcare burden; the burden associated with its complication is greater than those associated with the primary condition. Some researchers postulate that administering testosterone to men might reverse insulin resistance; whether low testosterone is a cause or effect of diabetes is an outstanding question.

Researchers at the Institute of Post Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Calcutta, India, have summarized current knowledge and research in a review article published in the October 2014 issue of Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy.

These authors start with a review of low testosterone in diabetes, with most studies confirming a higher prevalence of both low testosterone and also lower levels of sex hormone binding globulin (SHBG) in diabetic men. They report that possible mechanisms include visceral obesity, with testosterone levels falling as obesity increases. Here, they describe an inflammatory process that may cause or contribute to systemic changes. Leptin and metabolic syndrome-related androgen receptor polymorphism may also alter testosterone.

Low total testosterone in men has been associated with increased cardiometabolic risk, dyslipidemia and atherosclerosis, and increased mortality rates. The authors summarize several studies, and discuss their conflicting findings. They also note that most studies have been short-term, and without long-term studies, all findings are preliminary.

A key section of the paper reviews testosterone therapy’s adverse effects in patients with type 2 diabetes mellitus because it shows that testosterone therapy has unique concerns when used in diabetics. Several studies have reported increased risk of myocardial infarction after initiation of testosterone therapy. Testosterone-treated men appear to be at higher risk of prostate pathology than placebo-treated men, and often have higher hematocrits. Conversely, testosterone-treated men may respond with longer time-t-o- exercise-induced ischemia, and reduced body mass index and triglycerides. The authors’ opinion based on this review is that testosterone replacement is safe and possibly beneficial in men who are free of atherosclerotic vascular disease.