Testosterone Therapy Can Be a Game-changer in the Fight Against Diabetes

As men age, the dual burden of low testosterone and diabetes becomes more and more dreadful. But what if there is a game-changing solution that can transform the lives of millions of men wrestling with both conditions?

Read on to discover how testosterone therapy shows its potential to revolutionize blood sugar management in the fight against diabetes.

RELATED: All Benefits of Testosterone Therapy: A Near-panacea for Male Hypogonadism

Low testosterone and blood sugar levels share a complex, bidirectional relationship. Men with diabetes are more likely to have low testosterone; conversely, men with low testosterone are at an increased risk of developing diabetes.

This connection is primarily attributed to testosterone’s role in enhancing the body’s ability to utilize blood sugar in response to insulin. In men with low testosterone, insulin resistance is more common, necessitating increased insulin production to maintain normal blood sugar levels. Insulin resistance is a crucial precursor to the development of diabetes.

On the other hand, men with diabetes often exhibit an unfavorable metabolic profile characterized by factors such as obesity, insulin resistance, and an adverse lipid profile, further underscoring the link between low testosterone and diabetes.

Testosterone levels are considered low when they fall below 300 ng/dL, but this threshold can vary depending on the laboratory and the clinical context. Clinical assessment, including symptoms and medical history, is essential to diagnose low testosterone accurately.

RELATED: Why is There a Steady Decrease in Testosterone Levels of Men in the US?

The association between low testosterone and diabetes is prevalent:

• As many as half of all men diagnosed with diabetes also have low testosterone.
• Men with diabetes are twice as likely to experience low testosterone compared to men without diabetes.
• Hypogonadism, characterized by low testosterone levels, affects between 5.1% and 12.3% of men aged 30 to 79, with an incidence rate of 12.2/1000 people.
• A major testosterone study with 788 men over 65 (baseline testosterone level: 9.51 mmol/L) reveals 72% obese and 37% diabetic.

These statistics highlight the close relationship between testosterone and diabetes, emphasizing the need for potential interventions to address both conditions.

Glycemic control refers to managing blood sugar levels within a healthy range:

• Good glycemic control (fasting blood glucose of 80-130 mg/dL) means maintaining stable blood sugar levels and avoiding frequent spikes and drops. This is achieved through a combination of diet, exercise, and medication in some cases.
• Poor glycemic control (>130 mg/dL) occurs when blood sugar levels are consistently elevated, indicating a lack of control over diabetes. Poor glycemic control is associated with an increased risk of complications and poor health.

Improving glycemic control involves:

• Making lifestyle changes
• Dietary choices
• Closely monitoring blood sugar
• Physical activity
• Medications
• Adhering to treatment plans

Hemoglobin A1c (HbA1c) is a blood test measuring average blood sugar levels over the past 2-3 months. A normal HbA1c level varies by age, but it should be below 5.7% for most adults. An HbA1c level of 6.5% or higher indicates diabetes.

What is Testosterone Therapy?

Testosterone replacement therapy (TRT) involves administering exogenous testosterone to individuals with clinically confirmed low testosterone levels.

TRT aims to restore testosterone levels to within the normal testosterone range (300-1,000 ng/dL or 10-35 nmol/L) and alleviate the symptoms of low testosterone.

Studies have shown that TRT can improve glycemic control and testosterone levels in hypogonadal men with diabetes. Also, it has been observed that TRT can:

• Reduce total cholesterol
• Reduce triglycerides (high triglycerides contribute to hardening of the arteries)
• Reduce LDL cholesterol
• Increase HDL cholesterol (HDL can also be referred to as the “good” cholesterol because it prevents heart attacks and strokes at healthy levels)

Testosterone Therapy for Diabetes: Clinical Evidence

A systematic review and meta-analysis published in Clinics and Practice found that TRT significantly reduces fasting serum glucose (FSG), fasting serum insulin (FSI), and HbA1c levels in hypogonadal men with diabetes.

The analysis included 15 studies with a total of 3002 participants, and the results demonstrated that TRT reduced homeostatic model assessment for insulin resistance (HOMA-IR) levels more effectively than a placebo in 9 out of 15 studies.

Other findings of the analysis include:

• 14/15 studies showed a greater decrease in fasting serum glucose in the testosterone group compared to the placebo group.
• 8/15 studies indicated a greater reduction in fasting serum insulin in the TRT group.
• 13/15 studies revealed a significant improvement in post-treatment HbA1c levels among testosterone therapy patients.

RELATED: Testosterone Therapy May Help With Male Hypogonadism and Prediabetes

Emerging evidence suggests that testosterone therapy may also play a role in preventing the progression from prediabetes to diabetes in men with hypogonadism.

A study published in 2019 investigated this possibility and found that testosterone therapy could prevent type 2 diabetes in men with hypogonadism and prediabetes.

The study involved 316 men with prediabetes (defined by an HbA1c range of 5.7% to 6.4%) and hypogonadism. These participants were either treated with testosterone therapy or received no treatment.

Over 8 years of follow-up:

• The group receiving testosterone therapy experienced a 0.39% decrease in HbA1c levels, with 90% of participants achieving an HbA1c of less than 5.7%.
• The untreated group saw a 0.1% increase in HbA1c levels, and 40.2% progressed to diabetes, defined by an HbA1c greater than 6.5%.

Again, these results show a strong link between testosterone and diabetes. Using testosterone therapy may help men with hypogonadism and prediabetes avoid getting diabetes.

Testosterone therapy is generally considered safe for individuals with diabetes. However, like any medical intervention, it is not without potential side effects.

Common side effects of testosterone therapy can include:

• Acne
• Mood swings
• Enlarging breasts
• Hair loss
• Difficulty sustaining erections
• Weight gain
• Oily skin
• Smaller testes
• Impaired sperm production

Moreover, there have been concerns regarding potential cardiovascular risks associated with testosterone therapy, although the evidence remains inconclusive.

Given the potential risks in response to TRT, individuals with diabetes must discuss their health status and any underlying cardiovascular concerns with their healthcare provider before starting testosterone therapy.

Further research is needed to establish a more comprehensive understanding of the safety profile of testosterone therapy in the context of diabetes.

RELATED: Is Testosterone Replacement Therapy Safe? Potential TRT Side Effects You Should Know

For individuals who prefer to explore natural methods to manage testosterone and diabetes, several lifestyle modifications can be beneficial:

• Diet: A balanced and nutrient-rich diet, including foods high in zinc, vitamin D, and omega-3 fatty acids, can support testosterone production. Reducing processed sugars and maintaining a healthy weight can help manage blood sugar levels.
• Exercise: Regular physical activity, including cardiovascular and strength training exercises, can boost testosterone levels and improve glycemic control. Aim for at least 75 minutes of vigorous or 150 minutes of moderate-intensity exercise per week.
• Weight Management: Maintaining a healthy weight is crucial for managing diabetes and improving testosterone levels. Even modest weight loss can lead to significant improvements in both areas.
• Stress Reduction: Chronic stress can affect testosterone and blood sugar levels

References:

• Lutz S. et al. (2019). Sex-specific Associations of Testosterone With Metabolic Traits. Frontiers in Endocrinology.
• Gagliano-Jucá T. et al. (2019). Testosterone Replacement Therapy and Cardiovascular Risk. Nature Reviews Cardiology.
• Kumari K. et al. (2023). Treatment with Testosterone Therapy in Type 2 Diabetic Hypogonadal Adult Males: A Systematic Review and Meta-Analysis. Clinics and Practice.

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