Testosterone Deficiency Syndrome Risk In 50% Men With Type 2 Diabetes

Main Category: Diabetes
Also Included In: Endocrinology
Article Date: 15 Mar 2009 - 1:00 PST

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Data presented today at the Diabetes UK Annual Conference reveal that Testosterone Deficiency Syndrome (TDS) is found in over 50% of men with Type 2 diabetes, more than double the rate in the non-diabetic population1. TDS is associated with a 42% additional risk of developing Type 2 diabetes, and up to 60% additional risk of all-cause and coronary heart disease (CHD) mortality1.

TDS, also known as hypogonadism, describes symptomatic patients with low serum testosterone levels (generally below 12 nmol/L)2. TDS is estimated to affect one in ten men over the age of 50 years3. The data, presented by Dr Geoff Hackett and Professor Hugh Jones reveal that TDS is associated with insulin resistance, raised HbA1c, visceral adiposity, raised BMI and ED, all of which are significant CHD risk factors1.

Dr Geoff Hackett, Consultant in Sexual Medicine, Good Hope Hospital, Sutton Coldfield said; "Testosterone Deficiency Syndrome is more common than GPs realise, particularly amongst men with Type 2 diabetes. Erectile dysfunction has been shown to be a robust predictor of CHD risk in men with Type 2 diabetes and yet neither testing for low testosterone nor ED assessment are part of the QOF. Assessment of testosterone is regarded as mandatory by all published authoritative guidelines on ED management."

TDS can be treated with testosterone therapy. Data presented reveal that testosterone therapy in hypogonadal diabetic men, reduces insulin resistance and has beneficial effects on glycaemic control, waist circumference, leptin and cholesterol4.

Recently published recommendations on the identification, monitoring and treatment of hypogonadism have been formulated by major international scientific organisations, including the European Association of Urology, the European Society of Endocrinology and the European Academy of Andrology2. These state that all patients presenting with Type 2 diabetes or with ED, should have their serum testosterone levels measured on a blood sample taken in the morning between 07.00 and 11.002.

Professor Hugh Jones, Hon. Professor of Andrology and Consultant Physician and Endocrinologist, Barnsley Hospital NHS Foundation Trust, explains; "There is now substantial evidence that there is an increased prevalence of hypogonadism in men with Type 2 diabetes. Doctors should check early morning testosterone levels in men with Type 2 diabetes and symptoms of hypogonadism, which includes erectile dysfunction (ED). Testosterone therapy has in some men with diabetes been shown to improve ED and convert some who fail to respond to PDE 5 inhibitors to responders. If testosterone levels in symptomatic patients are found to be low or near the lower end of the normal range (generally below 12 nmol/l) on at least two occasions, then referral to a specialist for further investigation and treatment should be considered."

References

1. Hackett G. Data presented at Diabetes UK Annual Conference 2009

2. Wang C et al. ISA, ISSAM, EAU, EAA and ASA Recommendations: Investigation, Treatment and Monitoring of Late-Onset Hypogonadism in Males. The Aging Male 2008; 1-8

3. Wylie K. Dealing with Male Sexual Dysfunction. Testosterone Replacement. NHS Sheffield Care Trust. 2006

4. Jones TH. Data presented at Diabetes UK Annual Conference 2009. Hypogonadism and Diabetes - The Benefits of Testosterone Therapy in Men with Diabetes and Hypogonadism

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