Diet & Exercise & Transdermal Testosterone Reverses Metabolic Syndrome And Improves Glycaemic Control In Men With Newly Diagnosed Type 2 Diabetes

Main Category: Diabetes
Also Included In: Urology / Nephrology;  Men's health;  Endocrinology
Article Date: 10 Sep 2009 - 1:00 PDT

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UroToday.com - It was formerly firmly believed that testosterone had no essential role to play in male physiology, other than on sexual and reproductive functioning.

Over the last three decades it has become apparent that testosterone plays a significant role in glucose homeostasis and lipid metabolism. The metabolic syndrome is a clustering of risk factors predisposing to diabetes mellitus type 2, atherosclerosis and cardiovascular morbidity and mortality. The main components of the syndrome are visceral obesity, insulin resistance, glucose intolerance, raised blood pressure and dyslipidemia (elevated triglycerides, low levels of high-density lipoprotein cholesterol), and a pro-inflammatory and thrombogenic state. Cross-sectional epidemiological studies have reported a direct correlation between plasma testosterone and insulin sensitivity, and low testosterone levels are associated with an increased risk of type 2 diabetes mellitus, dramatically illustrated by androgen deprivation in men with prostate carcinoma. Recent epidemiological studies have found that low testosterone levels are a predictor of mortality in elderly men.

Lower total testosterone and sex hormone-binding globulin predict a higher incidence of the metabolic syndrome. There is now evidence to argue that hypotestosteronemia should be an element in the definition of the metabolic syndrome since low levels of testosterone are associated with / predict the development of the metabolic syndrome and of diabetes mellitus.

Administration of testosterone to hypogonadal men reverses part of the unfavorable risk profile for the development of diabetes and atherosclerosis and improves insulin sensitivity. So far, studies with clinical endpoints on the effects of normalization of testosterone in hypogonadal men on glucose homeostasis are limited but convincing, and if diabetes mellitus is viewed in the context of the metabolic syndrome, the present results of testosterone treatment are very encouraging. Physicians will have to change their mind-set and accept that testosterone is a vital hormone for men's health. Usually, physicians who treat men with diabetes mellitus are not very familiar with the (patho)physiology of testosterone, as indicated above, traditionally thought to serve sexual functioning only. It is to be hoped that these physicians develop a broader view of the functions of testosterone in adult life and in old age. Testosterone will not be a panacea, but treatment of diabetes mellitus type 2 is rarely based on a single entity. Our study proved that testosterone, in addition to the salutary effects of exercise and diet, improved glycemic control and in not a few patients led to a health status no longer qualifying as the metabolic syndrome.

Written by Louis J. Gooren, MD as part of Beyond the Abstract on UroToday.com.

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