Testosterone Replacement Therapy For Diabetes Management
Categories : Treatments
The link may not seem obvious at first, but low levels of testosterone and diabetes often go hand in hand. In fact, men with type 2 diabetes are twice as likely to have low testosterone levels than men without diabetes.
Some of the factors of lifestyle that increase the risk of diabetes, also increase the risk of having low testosterone levels.
The good news is that, following a heart-healthy diet and exercise, certain treatments can help both treat low testosterone levels as diabetes.
Low testosterone levels and diabetes: What is the link?
Low levels of testosterone in men are associated with insulin resistance or reduced insulin sensitivity, says Ahmer Farooq, DO, assistant professor of urology at Loyola University Medical Center in Maywood, Illinois.
When there is insulin resistance, the body produces insulin but does not use it properly. As a result, glucose builds up in the blood instead of being entered into cells. Insulin resistance can lead to type 2 diabetes and increase the risk of a number of health problems, including heart disease.
A study published in 2013 in the journal BioMed Research International found that low testosterone levels can help predict whether a man will develop insulin resistance or type 2 diabetes in the future.
According to researchers, in a group of more than 300 obese and non-obese men, 44 percent had type 2 diabetes and low testosterone levels compared to 33 percent who had low testosterone levels, but did not have diabetes. The researchers also noted that 25 percent of people with type 2 diabetes and low testosterone levels were not obese, concluding that low testosterone is linked to insulin resistance independent of body weight.
However, body weight can be a factor. A 2010 study published in the journal Diabetes Care found an inverse relationship between body mass index (BMI) and testosterone levels in men with diabetes type 2. This means that as you increase the BMI of a man, his testosterone level falls. Obesity can also be a reversibly risk factor for low testosterone levels.
Research also suggests that testosterone deficiency could be a complication of type 2 diabetes that affects the pituitary gland. A 2004 study published in The Journal of Clinical Endocrinology & Metabolism found that a third of the 103 men with type 2 diabetes had low levels of what is called free testosterone, or circulating testosterone in the blood that is not bound to a protein called sex hormone binding globulin.
The researchers also found that the pituitary glands of these men were not producing enough luteinizing hormone, the hormone that triggers the production of testosterone in the testicles.
Treatment of diabetes and low testosterone levels
Symptoms of low testosterone may include decreased sex drive, erectile dysfunction, loss of muscle mass, depression and lack of energy. Low testosterone can also cause a decrease in bone mass and osteoporosis, as well as increased belly fat.
A heart-healthy diet and exercise should be part of the overall treatment for both low testosterone levels and diabetes. In fact, a 2011 study published in the Journal of Clinical Endocrinology & Metabolism found that certain changes in lifestyle, such as weight loss and regular exercise, not only increase testosterone levels, but also results in a number of other health benefits for overweight men with low testosterone and type 2 diabetes.
Another study published in 2013 in the journal Hormone and Metabolic Research showed that overweight men who consumed fewer calories each day experienced significant increases in testosterone levels.
In addition to lifestyle changes, the treatment plan prescribed for diabetes may include oral medications and / or insulin therapy. A study of 2014 published in the European Journal of Endocrinology showed that people who had only been diagnosed with diabetes, insulin treatment for diabetes also increases levels of binding globulin sex hormone, which results in more testosterone in the bloodstream.
If testosterone deficiency is a problem for you, your doctor may prescribe testosterone replacement therapy. It is important to follow up with your doctor or a certified diabetes educator when you follow these treatments. In some cases, testosterone replacement may increase sensitivity to insulin, and may need to adjust the treatment strategy for type 2 diabetes.
Could the testosterone replacement therapy benefit men with type 2 diabetes?
Men with type 2 diabetes and low testosterone levels can significantly benefit from testosterone treatment, according to a study published in the journal Diabetes Care.
With testosterone replacement therapy, fat decreased while muscle mass increased in men with diabetes.
The lead author, Dr. Paresh Dandona, Department of Medicine at the Jacobs School of Medicine and Biomedical Sciences at the University of Buffalo (UB), New York, and his coauthors already knew that low levels of testosterone coincide with the reduction significant sensitivity to insulin.
In 2004, they showed that there was a relationship between low testosterone levels and type 2 diabetes.
Six years later, they extended this conclusion to obesity. In a study of more than 2,000 men, it was observed that 33% of participants with type 2 diabetes were obese or not had low testosterone levels, as 25% of nondiabetic obese men.
In 2012, the team found that obese adolescents had 50% less testosterone than their slimmer peers.
Researchers have also linked obesity with oxidative stress and inflammation. Inflammatory mediators are known to interfere with insulin signaling.
Testosterone: anti-inflammatory and insulin-sensitizing?
In this study, the researchers hypothesized that testosterone may be an anti-inflammatory and insulin sensitizing agent, as it has been known for some time that testosterone reduces adiposity and increases skeletal muscle.
Participants were 94 men with type 2 diabetes, of which 44 had low testosterone levels.
Before treatment, those with low testosterone levels expressed genes that significantly lower insulin signaling and decreased insulin sensitivity levels.
Men with low testosterone levels were randomly assigned to receive an injection of testosterone or a placebo every week for 24 weeks.
Testosterone did not change body weight of men, but there was a reduction in total body fat 3 kilograms (more than 6 pounds), while muscle mass increases by the same amount.
There was also a dramatic increase in insulin sensitivity, as evidenced by a 32% increase in glucose uptake by tissues in response to insulin, and a similar increase in the expression of key genes that mediate signaling insulin. Fasting glucose levels also dropped significantly, 12 milligrams per deciliter.
Hemoglobin A1C levels (HbA1c) didn´t decreased, which is a necessary indicator that testosterone can help control diabetes. However, Dr. Dandona believes that a significant improvement in HbA1c can be seen in long term studies.
Is testosterone a hormone with metabolic implications?
This was the first definitive evidence that testosterone is an insulin sensitizer and thus, a metabolic hormone.
Treatment with testosterone in men, when indicated, improves sexual function and increases skeletal muscle strength and bone density.
For future studies, researchers are interested in studying how testosterone treatment may affect insulin resistance and inflammation in specific patient populations such as those with chronic renal insufficiency and hypogonadism.
Dr. Dandona and colleagues have previously reported that 2 out of 3 men with type 2 diabetes and chronic kidney disease have low levels of testosterone. Among dialysis patients, a remarkable 90% have low testosterone levels.