Diabetes is a chronic metabolic disorder that causes high blood glucose levels. This is due to insulin resistance or deficiency. The prevalence of diabetes has been increasing worldwide, and it is estimated that by 2045, the number of people with diabetes will reach 700 million (1). Testosterone is an essential hormone that plays a vital role in the regulation of glucose metabolism, and its deficiency is associated with an increased risk of diabetes (2). Recent studies have shown that testosterone replacement therapy (TRT) in men with diabetes can improve glycemic control, reduce insulin resistance, and improve cardiovascular risk factors. I
Low testosterone levels are associated with an increased risk of developing type 2 diabetes. Studies have shown that testosterone deficiency is prevalent in men with diabetes, and it is more severe in those with poor glycemic control (3).
Testosterone plays a crucial role in glucose homeostasis, and its deficiency can impair insulin sensitivity and glucose uptake in peripheral tissues (4). Testosterone also improves insulin sensitivity by reducing adipose tissue mass and enhancing muscle mass, which are both essential in glucose metabolism (5). Therefore, restoring testosterone levels in men with diabetes may improve glucose metabolism and reduce the risk of developing complications associated with diabetes.
Testosterone replacement therapy has also been shown to improve glycemic control in men with diabetes. A randomised controlled trial involving 52 men with diabetes and testosterone deficiency showed that six months of testosterone treatment significantly reduced HbA1c levels, fasting glucose, and insulin resistance compared to placebo (6).
Another study involving 24 men with diabetes and low testosterone levels showed that testosterone replacement therapy improved insulin sensitivity, glucose uptake, and glycemic control (7). Testosterone replacement therapy was also found to reduce inflammation and oxidative stress, which are risk factors for cardiovascular disease in men with diabetes (8).
Some studies have shown that testosterone replacement therapy can improve cardiovascular risk factors. A systematic review and meta-analysis of randomised controlled trials involving men with testosterone deficiency and type 2 diabetes showed that testosterone replacement therapy significantly reduced waist circumference, body mass index, and systolic blood pressure, which are risk factors for cardiovascular disease (9).
Testosterone deficiency is prevalent in men with diabetes and is associated with an increased risk of developing complications associated with diabetes. Testosterone replacement therapy has been shown to improve glycemic control, reduce insulin resistance, and improve cardiovascular risk factors in men with diabetes. Therefore, the use of testosterone replacement therapy in men with diabetes should be carefully evaluated, and the potential benefits and risks should be considered.
Testosterone replacement therapy can cause side effects, such as acne, mood swings, and fluid retention and impact fertility. Therefore, men undergoing testosterone replacement therapy should be closely monitored.
Testosterone replacement therapy is a valuable treatment option for men with diabetes and testosterone deficiency. It can improve glycemic control, reduce insulin resistance, and improve cardiovascular risk factors.
- International Diabetes Federation. IDF Diabetes Atlas, 9th edn. Brussels, Belgium: International Diabetes Federation, 2019.
- Grossmann M. Low testosterone in men with type 2 diabetes: significance and treatment. J Clin Endocrinol Metab. 2011; 96(8): 2341-2353.
- Dhindsa S, Prabhakar S, Sethi M, et al. Frequent occurrence of hypogonadotropic hypogonadism in type 2 diabetes. J Clin Endocrinol Metab. 2004; 89(11): 5462-5468.
- Kapoor D, Aldred H, Clark S, et al. Clinical and biochemical assessment of hypogonadism in men with type 2 diabetes: correlations with bioavailable testosterone and visceral adiposity. Diabetes Care. 2007; 30(4): 911-917.
- Kalyani RR, Dobs AS. Androgen deficiency, diabetes, and the metabolic syndrome in men. Curr Opin Endocrinol Diabetes Obes. 2007; 14(3): 226-234.
- Jones TH, Arver S, Behre HM, et al. Testosterone replacement in hypogonadal men with type 2 diabetes and/or metabolic syndrome (the TIMES2 study). Diabetes Care. 2011; 34(4): 828-837.
- Kapoor D, Goodwin E, Channer KS, et al. Testosterone replacement therapy improves insulin resistance, glycaemic control, visceral adiposity and hypercholesterolaemia in hypogonadal men with type 2 diabetes. Eur J Endocrinol. 2006; 154(6): 899-906.
- Traish AM. Testosterone and insulin resistance in the metabolic syndrome and T2DM in men. Nat Rev Endocrinol. 2018; 14(8): 479-493.
- Corona G, Giorda CB, Cucinotta D, et al. Testosterone deficiency and the metabolic syndrome. J Endocrinol Invest. 2011; 34(9): 667-672.
- Corona G, Maseroli E, Rastrelli G, et al. Cardiovascular risk associated with testosterone-boosting medications: a systematic review and meta-analysis. Expert Opin Drug Saf. 2014; 13(10): 1327-1351.
