Type 2 diabetes: How testosterone therapy can help manage condition

• Researchers say a new study indicates that testosterone replacement therapy helped men with type 2 diabetes.
• They said testosterone treatment can be beneficial for managing type 2 diabetes because the therapy can improve blood sugar as well as cholesterol levels.
• They noted that testosterone therapy can also benefit women with type 2 diabetes.

A new study suggests that testosterone therapy could benefit people with type 2 diabetes and obesity.

The research was being presented this week at the annual meeting of The European Association for the Study of Diabetes. The findings have not yet been published in a peer-reviewed journal.

In their study, researchers looked at data from an ongoing international audit of testosterone deficiency in men with type 2 diabetes.

The researchers reported that testosterone replacement therapy (TRT) improved glycemic control in men for up to 2 years.

The data came from 37 centers in the United Kingdom, Germany, Canada, New Zealand, South Africa, Malaysia, and Vietnam that joined the audit conducted by the Association of British Clinical Diabetologists (ABCD).

The study looked at 428 subjects with an average age of 71.

How testosterone may be linked to type 2 diabetes

The research team suggested the reason HbA1c (a measure of average blood sugar levels over 2 to 3 months) decreased over time in subjects can be attributed to the ongoing effect of testosterone on insulin resistance and fat reduction.

A statement released by the scientists said the results provide “preliminary insights into the controversial question of whether TRT could have a beneficial effect on diabetes and obesity.”

The team said that two decades ago researchers discovered a link between low testosterone in men and the prevalence of type 2 diabetes.

The statement said an estimated 40% of men with type 2 diabetes also have symptomatic testosterone deficiency, which is also linked to adverse effects on cardiovascular risk factors, osteoporosis, and psychological wellbeing. It’s also associated with twice the risk of death in men with type 2 diabetes.

How testosterone therapy can help with type 2 diabetes

ABCD officials said multiple studies have shown TRT could benefit men with hypogonadism (testosterone deficiency) who also have type 2 diabetes, obesity, and other cardiometabolic disorders.

TRT has been shown to reduce insulin resistance, HbA1c, cholesterol, obesity, and mortality, and improve quality of life, and sexual function.

“However, uptake of TRT has been slow in practice in part due to conflicting findings on cardiovascular risks,” ABCD officials said. “However, a recently published large, multicenter randomized trial on the cardiovascular safety of TRT found no difference in major cardiovascular events between testosterone and placebo treated groups.”

“Despite this evidence, the use of testosterone among endocrinologists remains low and many diabetologists have not even heard of the association between testosterone and diabetes,” said T. Hugh Jones, a professor and researcher on testosterone and type 2 diabetes as well as a consultant at Barnsley Hospital in the United Kingdom who led the study.

“We hope that the ABCD audit will provide enough data on real-world clinical practice to determine which patients respond and those who do not in terms of quality of life, symptoms and cardiometabolic benefits,” he added.

What the testosterone study revealed

The ABCD audit allowed anonymized data input from new and retrospective patients being treated with TRT as well as those with testosterone deficiency who weren’t treated with this therapy.

The audit was designed to determine real-world benefits and safety of TRT on symptoms, glycemic control, obesity, other cardiometabolic parameters (e.g., lipids, blood pressure, BMI, and waist circumference) and on cardiovascular events and diabetes complications.

Participants received testosterone via gels and long-acting testosterone undecanoate intramuscular injections. The ABCD officials said testosterone guidelines state that after initiation of TRT patients should be reviewed at 3, 6, and 12 months and then yearly moving forward.

Dr. Rekha Kumar, the chief medical officer at medical-assisted weight loss program Found and a practicing endocrinologist in New York City who wasn’t involved in the study, told Medical News Today the findings weren’t that surprising because testosterone increases muscle mass.

“A lack of muscle leads to insulin resistance and increases the risk of type 2 diabetes,” Kumar explained. “The first line treatments for insulin resistance are low carbohydrate diets, metformin, and strength training. Based on larger studies, we might want to pay more attention to testosterone levels to see if we should be using it more broadly in men with type 2 diabetes and low testosterone.”

“It can be hard to pinpoint what came first: the low testosterone or the diabetes,” Kumar noted. “Because of this, endocrinologists tend to avoid taking the cardiovascular risks that were previously associated with testosterone replacement therapy.”

Who can benefit from testosterone therapy

Dr. Florence Comite, an endocrinologist and founder of the Comite Center for Precision Medicine and Health and Groq Health who was not involved in the study, told Medical News Today it’s not just men who can benefit from more testosterone.

“Testosterone optimization in both men and women improves blood glucose control and insulin sensitivity,” Comite said. “Testosterone declines in the mid-30s in both men and women. The fall in testosterone has a profound negative impact, triggering muscle loss, aging, health decline, and the chronic disorders associated with aging such as diabetes, heart disease and Alzheimer’s disease.”

Dr. Bruce Dorr, a senior medical advisor for Biote, specializes in menopause and hormonal health and has been part of studies on TRT’s impact on bone density in men.

Dorr, who also was not involved in the study, told Medical News Today the link between male hypogonadism and metabolic syndrome, which includes insulin resistance, has been clearly demonstrated. He said the link affects more people in the United States than one might think.

“Testosterone decreases insulin resistance, a condition estimated as affecting up to two-thirds of American adults,” Dorr expalined. “Insulin resistance results in a gain of fat, which is not oinly burdensome and estrogenic, but is also inflammatory, increasing the risks for vascular disease such as heart attack and stroke.”

Dorr added that the benefits of testosterone are many.

‘Replacing testosterone and its noted effects on energy, mood, libido, and sleep, in turn motivates people to diet, exercise and have healthier relationships,” he said.

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