February 22, 2012

Diabetes and Low Testosterone

Awareness of Diabetes and Low Testosterone

The Hidden Epidemic

Being diagnosed with type 2 diabetes is something you do not want to hear. But, if you’re a man the news may even be worse. Men with type 2 diabetes are twice as likely to suffer from low testosterone as men without diabetes. Diabetes and low testosterone are duel threats to a man’s health. The combination of diabetes and low testosterone is common, but unrecognized, and sometimes referred to as a hidden epidemic.

The Connection Between Diabetes and Low Testosterone

How is diabetes and low testosterone connected? Low testosterone levels can be related to failure of the testes to make testosterone, or what’s called primary hypogonadism.  Or, it can be related to problems involving the hypothalamus or pituitary which secrete hormones that tell the testes to make testosterone.  A failure at the hypothalamus or pituitary is called secondary hypogonadism or hypogonadotropic hypogonadism.

Luteininzing hormone, or LH is secreted by the pituitary and stimulates the Leydig cells in the testes to make testosterone. In type 2 diabetics LH levels are disproportionately low compared to levels in non-diabetic men. Why that is is not entirely clear. But, the end result is low LH leads to lower testosterone levels.

Here’s what is important to know. This decline in LH holds true irrespective of how well the blood sugar is controlled. And, the decline in LH occurs in presence or absence of complications of diabetes or obesity. So while good blood sugar control reduces the chances of diabetic complications, good control of blood sugar does not protect against the development of unhealthy testosterone levels.

The point is you don’t want to develop even a mild case of type 2 diabetes. Testoserone is not just a sex and muscle hormone. It’s also a brain hormone, bone hormone, and heart hormone.

Impact of Low T in Diabetics

Erectile dysfunction is more common in diabetics and is related to blood flow and testosterone levels. Diabetics are at risk of cardiovascular disease hindering the blood flow. Throw in the low T and you have the perfect storm for erectile dysfunction.

Low T also contributes to the increase in body fat seen in type 2 diabetics as testosterone plays a huge role in maintaining lean body mass.  Low T means lower lean body mass which means lower metabolism and a tendency to gain fat. Low testosterone affects mood and predisposes to depression which is already in higher in diabetics. Low T also contributes to low energy levels and energy is affected by fluctuating blood sugar levels that occur in diabetics.

Diabetes and low testosterone can both adversely affect cholesterol levels and raise the risk of metabolic syndrome.

What to Do?

If you’re a male diabetic you should strongly consider being screened for low T.  It’s important to have a total testosterone level measured, but also a free testosterone level, or some measurement of bioavailable testosterone. You want to know how much testosterone is available to enter the cells and tissues and this can be determined by a free testosterone, or bioavailable testosterone.

Treatment for Low T

There are many options for testosterone replacement therapy. The 2 most common approaches are either to use intramuscular injections of testosterone usually performed weekly, or daily application of transdermal creams.  There are advantages and disadvantages to both, but we favor injections as achieveing good blood testosterone levels is more predictable. See our other posts on testosterone replacement,”Treatment for a Low Testosterone Level“, “Androgen Replacement Therapy“, “How to Increase Testosterone Levels“, and “Testosterone Therapy“.

For more information on diabetes and low testosterone go to the American Diabetes Association.

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Dr. Joe Jacko


Dr. Joe is board certified in internal medicine and sports medicine with additional training in hormone replacement therapy and regenerative medicine. He has trained or practiced at leading institutions including the Hughston Clinic, Cooper Clinic, Steadman-Hawkins Clinic of the Carolinas, and Cenegenics. He currently practices in Columbus, Ohio. Read more about Dr. Joe Jacko

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