Low Testosterone Associated With Obesity and the Metabolic Syndrome Contributes to Sexual Dysfunction and Cardiovascular Disease Risk in Men With Type 2 Diabetes (original) (raw)
Obesity, low testosterone levels and erectile dysfunction
International Journal of Impotence Research, 2009
Obesity is an important risk factor for many common diseases including cardiovascular disease (CVD), type 2 diabetes, cancer and erectile dysfunction (ED). Adipose tissues produce a number of adipokines and cytokines, which affect endothelial and metabolic function resulting in insulin resistance and the metabolic syndrome (risks factors for CVD). Both ED and metabolic syndrome improve with a reduction in body mass index (BMI). The relationships among obesity, metabolic syndrome, ED, sex hormonebinding globulin (SHBG) and serum total and free testosterone levels are complex and often confusing to the physician. It is known that BMI is inversely proportional to serum total testosterone concentrations; low serum SHBG levels in obesity contribute to the low serum total testosterone. Recent studies show that BMI is also inversely proportional to free testosterone concentration. The characteristic low serum testosterone concentrations observed in obese men are also present in men with the metabolic syndrome and type 2 diabetes mellitus. A small proportion of men with ED have hypogonadism; however, the proportion increases if these men are obese with manifestations of the metabolic syndrome or type 2 diabetes mellitus. ED is a common symptom in patients with type 2 diabetes who also have low testosterone levels. This review describes the relationships between low serum testosterone concentrations and ED in obese patients and those with metabolic syndrome and type 2 diabetes mellitus.
International Journal of Andrology, 2007
Low testosterone levels in men are associated with type 2 diabetes mellitus. Erectile dysfunction (ED) is a frequent complication of type 2 diabetes. The aim of our cross-sectional study was to investigate the relationship between ED and total, bioavailable and free testosterone levels in 198 men with type 2 diabetes. In addition, we examined the associations of various cardiovascular risk factors involved in the development of ED in type 2 diabetic men. We found that bioavailable and free testosterone levels were significantly lower in men with ED (p = 0.006 and 0.027 respectively) than those without ED. Sex hormone-binding globulin levels were also reduced, but there was no significant difference in total testosterone (TT) levels between men with and without ED. The severity of ED as assessed by International Index of Erectile Function scores was significantly associated with TT (r = 0.32; p < 0.001), bioavailable testosterone (r = 0.32; p < 0.001) and calculated free testosterone (r = 0.35; p < 0.001) levels. ED was more frequently observed in men with hypertension and a higher waist circumference (p = 0.03). There was also a higher prevalence of ED among smokers (p = 0.06), but there were no significant associations between ED and alcohol consumption or with BMI > 30. This study has shown that ED is associated with low bioavailable and free testosterone levels, age, visceral adiposity and hypertension in type 2 diabetic men.
Advances in Sexual Medicine
Background: Some evidence has shown that the prevalence of hypoactive sexual desire and erectile dysfunction (ED) is associated with testosterone levels whilst higher levels of testosterone have been reported to increase the frequency of intercourse. Available evidence points towards an etiologic role for hypogonadism in the causation of diabetes, metabolic syndrome (Mets) and sexual dysfunction (SD) even though the exact pathophysiological linkage is yet to be fully elucidated. This study therefore sought to evaluate the impact of testosterone as well as its bioactive components on both the MetS and SD. Method: Diabetic men engaged in a stable heterosexual relationship for at least 2 years were recruited for this study. Participants were at least 18 years and provided an informed and signed consent to partake in this study. Fasting blood samples were taken from the participants for biochemical and hormonal assay. The participants were then evaluated using the Golombok Rust Inventory of Sexual Satisfaction for males (GRISS-M). Metabolic syndrome was assessed using the NCEP-ATP III, IDF and WHO criteria. All data analyses were performed using the SPSS software, version 11.0 systat, Inc. Germany and GraphPad Prism, version 5.0, San Diego California, USA. Results: The mean total, free and bioavailable testosterone as well as SHBG recorded among the participants was 7.10 ± 1.23 ng/ml, 0.10 ± 0.01 ng/ml, 7.01 ± 1.41 ng/ml and 4.33 ± 1.12 nmol/l respectively. Subjects with the MetS showed significantly lower SHBG levels in comparison with subjects without the MetS. Participants with raised triglyceride levels showed significantly lower levels of total, free and bioavailable testosterone when compared to participant without How to cite this paper:
The Journal of Sexual Medicine, 2011
One of the factors involved in type 2 diabetes in males is a reduction in levels of testosterone, which has been shown to predict resistance to insulin and the development of cardiovascular diseases. Aim. To assess the levels of testosterone in patients with type 2 diabetes and to evaluate their relationship with cardiovascular risk factors, peripheral arterial disease (PAD) and silent myocardial ischemia (SMI). Methods. Total testosterone and sex hormone binding globulin were measured and free and bioavailable testosterones were calculated using Vermeulen's formula. Levels of total testosterone Ն12 nmol/L or free testosterone >225 pmol/L were considered normal. PAD was evaluated using the ankle-brachial index. SMI was assessed using a baseline ECG, Doppler echocardiogram, 24-hour electrocardiogram (ECG) Holter, exercise stress testing (EST), nuclear stress (if EST inconclusive), and if the result was positive, a coronary angiography. Main Outcome Measures. PAD, SMI, testosterone, erectile dysfunction, 24-hour blood pressure Holter, body mass index (BMI), waist circumference, lipid profile, insulin resistance, chronic inflammation, United Kingdom Prospective Diabetes Study cardiovascular risk score, nephropathy, retinopathy, and neuropathy. Results. The study population was composed of 192 diabetic males with a mean age of 56.1 Ϯ 7.8 years and without a history of vascular disease. Twenty-three percent presented total testosterone below normal and 21.8% presented low free testosterone. BMI, waist circumference, neuropathy, triglycerides, C-reactive protein (CRP), glucose, insulin, and HOMA-IR were found to be significantly incremented with respect to subjects with normal testosterone. There was a negative correlation of HOMA-IR with total testosterone. PAD was detected in 12% and SMI in 10.9% of subjects, and differences were not related to testosterone levels. Conclusions. We have verified the prevalence of low testosterone levels in male patients with type 2 diabetes and have related them to variations in BMI, waist circumference, neuropathy, triglycerides, CRP, glucose, insulin and HOMA-IR, but not with an increase of SMI or PAD. Hernández-Mijares A, García-Malpartida K, Solá-Izquierdo E, Bañuls C, Rocha M, Gómez-Martínez MJ, Mármol R, and Víctor VM. Testosterone levels in males with type 2 diabetes and their relationship with cardiovascular risk factors and cardiovascular disease.
Journal of Diabetes Investigation, 2014
A significant proportion of patients with type 2 diabetes mellitus have a low testosterone level relative to reference ranges based on healthy young men. Only a small number of these patients suffer from classical hypogonadism as a result of recognizable hypothalamic-pituitary-gonadal axis pathology. The cutoff value of the serum testosterone level in men without obvious hypothalamic-pituitary-gonadal axis pathology is controversial. It is unclear to what extent a low serum testosterone level causally leads to type 2 diabetes and/or the metabolic syndrome. From a theoretical standpoint, there can be complex interactions among the hypothalamic-pituitary-gonadal axis, body composition and insulin resistance, which can be further influenced by intrinsic and extrinsic factors to give rise to metabolic syndrome, glucose intolerance, and low-grade inflammation to increase the risk of cardiovascular disease. Although a low serum testosterone level frequently coexists with cardiometabolic risk factors and might serve as a biomarker, more studies are required to clarify the causal, mediating or modifying roles of low serum testosterone level in the development of adverse clinical outcomes. Currently, there are insufficient randomized clinical trial data to evaluate the effects of testosterone replacement therapy on meaningful clinical outcomes. The risk-to-benefit ratio of testosterone therapy in high-risk subjects, such as those with type 2 diabetes, also requires elucidation. The present article aims to review the current evidence on low serum testosterone levels in patients with type 2 diabetes, and its implications on cardiovascular risk factors, metabolic syndrome and adverse clinical outcomes.
The Journal of Sexual Medicine, 2007
Introduction. Type 2 diabetes mellitus (T2DM) and metabolic syndrome (MetS) are characterized by insulin resistance and often associated with male hypogonadism. Aim. To discriminate the specific contribution of T2DM and MetS to male hypogonadism. Methods. A consecutive series of 1,134 (mean age 52.1 Ϯ 13 years) male patients with sexual dysfunction was studied. Main Outcome Measures. Several hormonal and biochemical parameters were studied along with ANDROTEST, a 12-item validated structured interview, specifically designed for the screening of hypogonadism (total testosterone [TT] <10.4 nmol/L or free testosterone [FT] <37 pmol/L) in a male population with sexual dysfunction. Results. Irrespective of the criteria used to define hypogonadism, MetS was associated with a significantly higher prevalence of the condition, both in subjects with and without T2DM (41% and 29% vs. 13.2% and 77.1% and 58% vs. 40.6%, respectively, for TT and FT in patients with MetS and with or without T2DM, when compared with subjects without MetS and T2DM; both P < 0.0001). Conversely, T2DM was associated with a higher prevalence of hypogonadism in subjects with MetS but not in those without MetS. Patients with MetS, with or without T2DM, also showed a higher ANDROTEST score when compared with patients without MetS. Logistic multivariate regression analysis, incorporating the five components of MetS, identified a significant association of elevated waist circumference and hypertriglyceridemia with hypogonadism both in patients, with or without T2DM. Conclusions. Our study demonstrated that MetS, and in particular visceral adiposity (as assessed by increased waistline and hypertriglyceridemia), is specifically associated with hypogonadism in subjects consulting for sexual dysfunction.
Serum testosterone levels and clinical signs of hypogonadism in men with type 2 diabetes
2021
Men are biologically more prone to type 2 diabetes than women. Studies show that the men with overweight are more likely to get the disease than women. The distribution of fat in the body of an obese person plays an important role in this regard. Because in men, most of the body fat is stored in the liver and around the abdomen and this feature is the most important factor in increasing the risk of diabetes. But instead, women store a lot of fat in the thighs and pelvis. This difference suggests that women need to be fatter than men to develop diabetes. Androgens play a very important role in the development and maintenance of male reproductive and sexual functions, body composition, bone health and behavior. Male hypogonadism is a clinical syndrome caused by androgen deficiency and may have adverse effects on the function of various organs and their quality of life. Androgen deficiency increases by age and also slightly in healthy men. In middle-aged men, the incidence of biochemic...
European Journal of Medical Research, 2014
Background: Multiple epidemiological studies have shown that low testosterone levels are associated with and predict the future development of type 2 diabetes mellitus and the metabolic syndrome. The aim of our study was to show the influence of testosterone replacement therapy on obesity, HbA1c level, hypertension and dyslipidemia in patients with diabetes mellitus and androgen deficiency. Methods: One hundred and twenty-five male patients with diabetes mellitus were screened; 85 subjects aged 41 to 65 years, with BMI from 27.0 to 48.0 kg/m 2 , were randomized in a placebo-controlled study. They also underwent a routine physical examination and selected by free testosterone examination. We divided patients into two groups: 1) treatment group, where we used diet, physical activity, patient's antidiabetic therapy and testosterone replacement therapy; 2) placebo group, where we used diet, physical activity, patient's antidiabetic therapy and placebo. Results: After 6 months of treatment we repeated the diagnostic assessments: lipid profile was improved in both groups but in first group it was clinically significant. Free testosterone level increased in all groups, but in group I was clinically significant. HbA1c decreased in both groups, but in group I we obtained the best result. Leptin level after treatment was approximately the same in both groups. Also, blood pressure was reduced in both groups but results were similar. Conclusions: Our study demonstrated that it is possible to break this metabolic vicious circle by raising testosterone levels in diabetic men with androgen deficiency. Re-instituting physiological levels of testosterone, as the study has shown, has an important role in reducing the prevalence of diabetic complications.