TESTOSTERONE LEVEL IN TYPE 2 DIABETIC MALE PATIENTS
Hemn Muhammed Mustafa a, Fattah Hama Rahim Fattah b, and Ibrahim Talib Salih c
a College of Medicine, University of Sulaimani, Kurdistan Region, Iraq.
b Department of Community Medicine, College of Medicine, University of Sulaimani, Kurdistan Region.
c College of Medicine, University of Sulaimani, Kurdistan Region, Iraq.
Submitted: 15/3/2019; Accepted: 16/2/2020; Published: 21/3/2020
DOI Link: https://doi.org/10.17656/jsmc.10235
The relationship between diabetes mellitus and testosterone level is a remarkable issue, given the fact that diabetes is rapidly -growing disease, the morbidity is more disabling than the diabetes itself.
The aim is to study testosterone levels in men with type 2 diabetes mellitus in age group of 35-55 years.
Patients and Methods
In this study 100 male type 2 diabetic patients in age group of 35-55 years were assessed by testosterone and HbA1c level estimation along with other clinical variables like BMI, smoking, alcohol drinking status and types of medications.
In the current study among those patients with controlled diabetes, 92.1 % had normal testosterone level as compared to 67.7% of those with uncontrolled diabetes, so there is statistically significant relationship between the control status of diabetes and testosterone level, the P-value was 0.003, while the relation of testosterone level with age of patients, BMI, smoking, alcohol drinking status and types of medication were found to be not significant.
Uncontrolled diabetes is associated with lower testosterone level as compared to those with well-controlled status.
Type 2 diabetes, Male, Testosterone.
1. Powers AC. Diabetes mellitus: diagnosis, classification, and pathophysiology. Harrison's Principles of Internal Medicine. 19th Ed. New York: McGraw Hill. 2015: 2399-407.
2. Oh JY, Barrett CE, Wedick NM, Wingard DL. Endogenous sex hormones and the development of type 2 diabetes in older men and women: the Rancho Bernardo study. Diabetes Care. 2002;25:55-60.
3. Kapoor D, Malkin CJ, Channer KS, Jones TH. Androgens, insulin resistance and vascular disease in men. Clin Endocrinol (Oxf). 2005;63:239-50.
4. Haffner SM, Shaten J, Stern MP, Low levels of sex hormone-binding globulin and testosterone predict the development of non-insulin-dependent diabetes mellitus in men. MRFIT Research Group. Multiple Risk Factor Intervention Trial. Am J Epidemiol 1996; 143: 889–897.
5. Stellato RK, Feldman HA, Hamdy O. Testosterone, sex hormone-binding globulin, and the development of type 2 diabetes in middle-aged men: prospective results from the Massachusetts male ageing study. Diabetes Care 2000; 23: 490–494.
6. Tsai EC, Matsumoto AM, Fujimoto WY. Association of bioavailable, free, and total testosterone with insulin resistance: influence of sex hormone-binding globulin and body fat. Diabetes Care 2004; 27: 861–868.
7. van den Beld AW, de Jong FH, Grobbee DE, Measures of bioavailable serum testosterone and estradiol and their relationships with muscle strength, bone density, and body composition in elderly men. J Clin Endocrinol Metab 2000; 85: 3276–3282.
8. Zmuda JM, Cauley JA, Kriska A, Longitudinal relation between endogenous testosterone and cardiovascular disease risk factors in middle-aged men. A 13-year follow-up of former Multiple Risk Factor Intervention Trial participants. Am J Epidemiol 1997; 146: 609–617.
9. Traish AM, Saad F, Feeley RJ, The dark side of testosterone deficiency: III. Cardiovascular disease. J Androl 2009; 30: 477–494.
10. Ma RC, Tong PC. Testosterone levels and cardiovascular disease. Heart 2010; 96: 1787–1788.
11. Akishita M, Hashimoto M, Ohike Y, Low testosterone level as a predictor of cardiovascular events in Japanese men with coronary risk factors. Atherosclerosis 2010; 210: 232–236.
12. Shores MM, Matsumoto AM, Sloan KL, Low serum testosterone and mortality in male veterans. Arch Intern Med 2006; 166: 1660–1665.
13. Corona G, Mannucci E, Petrone L, Ricca V, Balercia G, Mansani R, et al. Association of hypogonadism and type II diabetes in men attending an outpatient erectile dysfunction clinic. Int J Impot Res. 2006;18:190-7.
14. Maiorino MI, Bellastella G, Della Volpe E, Erectile dysfunction in young men with type 1 diabetes. Int J Impot Res 2017;29:17–22.
15. Al-Hunayan A, Al-Mutar M, Kehinde EO, The prevalence and predictors of erectile dysfunction in men with newly diagnosed with type 2 diabetes mellitus. BJU Int 2007;99:130–4.
16. Aversa A, Bruzziches R, Vitale C, Chronic sildenafil in men with diabetes and erectile dysfunction. Expert Opin Drug Metab Toxicol 2007;3:451–64.
17. Derosa G, Romano D, Tinelli C, Prevalence and associations of erectile dysfunction in a sample of Italian males with type 2 diabetes. Diabetes Res Clin Pract 2015;108:329–35.
18. Bhasin S, Cunningham GR, Hayes FJ, Matsumoto AM, Snyder PJ, Swerdloff RS, et al. Testosterone therapy in men with androgen deficiency syndromes: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2010;95 (6):2536–59 [Guideline Review].
19. Grossmann M, Thomas MC, Panagiotopoulos S, Sharpe K, Macisaac RJ, Clarke S, Zajac JD, Jerums G 2008 Low testosterone levels are common and associated with insulin resistance in men with diabetes. J Clin Endocrinol Metab 93:1834–1840
20. Stellato RK, Feldman HA, Hamdy O, Horton ES, McKinlay JB 2000, Testosterone, sex hormone-binding globulin, and the development of type 2 diabetes in middle-aged men: prospective results from the Massachusetts Male Aging Study. Diabetes Care 23:490–494
21. Oh JY, Barrett-Connor E, Wedick NM, Wingard DL 2002 Endogenous sex hormones and the development of type 2 diabetes in older men and women: the Rancho Bernardo Study. Diabetes Care 25:55–60.
22. Laaksonen DE, Niskanen L, Punnonen K, Nyysso¨ nen K, Tuomainen TP, Valkonen VP, Salonen R, Salonen JT 2004 Testosterone and sex hormone-binding globulin predict the metabolic syndrome and diabetes in middle-aged men. Diabetes Care 27:1036–1041
23. Vikan T, Schirmer H, Njølstad I, Svartberg J 2010 Low testosterone and sex hormone-binding globulin levels and high estradiol levels are independent predictors of type 2 diabetes in men. Eur J Endocrinol 162:747–754.
24. Lakshman KM, Bhasin S, Araujo AB 2010 Sex hormone-binding globulin as an independent predictor of incident type 2 diabetes mellitus in men. J Gerontol A Biol Sci Med Sci 65:503–509
25. Haffner SM, Shaten J, Stern MP, Smith GD, Kuller L 1996 Low levels of sex hormone-binding globulin and testosterone predict the development of non-insulin-dependent diabetes mellitus in men. MRFIT Research Group. Multiple Risk Factor Intervention Trial. Am J Epidemiol 143:889–897.
26. Yeap BB, Chubb SA, Hyde Z, Jamrozik K, Hankey GJ, Flicker L,Norman PE 2009 Lower serum testosterone is independently associated with insulin resistance in non-diabetic older men: the Health in Men Study. Eur J Endocrinol 161:591–598
27. Pitteloud N, Mootha VK, Dwyer AA, Hardin M, Lee H, Eriksson KF, Tripathy D, Yialamas M, Groop L, Elahi D, Hayes FJ 2005 Relationship between testosterone levels, insulin sensitivity, and mitochondrial function in men. Diabetes Care 28:1636–1642
28. Abate N, Haffner SM, Garg A, Peshock RM, GrundySM2002 Sex steroid hormones, upper body obesity, and insulin resistance. J Clin Endocrinol Metab 87:4522–4527.
29. Li C, Ford ES, Li B, Giles WH, Liu S 2010 Association of testosterone and sex hormone-binding globulin with metabolic syndrome and insulin resistance in men. Diabetes Care 33:1618–1624
30. Kupelian V, Hayes FJ, Link CL, Rosen R, McKinlay JB 2008 Inverse association of testosterone and the metabolic syndrome in men is consistent across race and ethnic groups. J Clin Endocrinol Metab 93:3403–3410
31. Corona G, Mannucci E, Petrone L, Balercia G, Paggi F, Fisher AD, Lotti F, Chiarini V, Fedele D, Forti G, Maggi M 2007 NCEPATPIII-defined metabolic syndrome, type 2 diabetes mellitus, and prevalence of hypogonadism in male patients with sexual dysfunction. J Sex Med 4:1038–1045.
32. Guzik TJ, Mangalat D, Korbut R. Adipocytokines: novel link between inflammation and vascular function? J Physiol Pharmacol. 2006;57:505–528.
33. Isidori AM, Caprio M, Stroll F, Leptin and androgens in male obesity: evidence for leptin contribution to reduced androgen levels. J Clin Endocrinol Metab. 1999;84:3673–3680.
34. Pitteloud N, Hardin M, Dwyer AA, Increasing insulin resistance is associated with a decrease in Leydig cell testosterone secretion in men. J Clin Endocrinol Metab. 2005;90:2636–2641.
35. Boots LR, Potter S, Potter D , Measurement of totalserum testosterone levels using commercially available kits: high degree of between-kit variability. Fertil Steril 1998; 69:286–292.
36. Bhasin S, Pencina M, Jasuja GK, Reference ranges for testosterone in men generated using liquid chromatography tandem mass spectrometry in a community-based sample of healthy nonobese young men in the Framingham Heart Study and applied to three geographically distinct cohorts. J Clin Endocrinol Metab 2011; 96: 2430–2439.
37. Dhindsa S, Miller MG, McWhirter CL, Mager DE, Ghanim H,Chaudhuri A, Dandona P 2010 Testosterone concentrations in diabetic and nondiabetic obese men. Diabetes Care 33:1186–1192.
38. Grossmann M, Gianatti EJ, Zajac JD 2010 Testosterone and type 2 diabetes. Curr Opin Endocrinol Diabetes Obes 17:247–256.
39. Traish AM, Saad F, Guay A 2009 The dark side of testosterone deficiency. II. Type 2 diabetes and insulin resistance. J Androl 30: 23–32.
40. Brand JS, Wareham NJ, Dowsett M, Folkerd E, van der Schouw YT, Luben RN, Khaw KT 15 December 2010 Associations of endogenous testosterone and SHBG with glycated haemoglobin in middle-aged and older men. Clin Endocrinol (Oxf) doi: 10.1111/ j.1365-2265.2010.03951.x
41. Svartberg J. (2007). Epidemiology: testosterone and the metabolic syndrome. Int. J. Impot. Res., 19 (2): 124-128.
42. Harman SM, Tsitouras PD. 1980 Reproductive hormones in ageing men. I. Measurement of sex steroids, basal luteinizing hormone and Leydig cell response to human chorionic gonadotropin. J Clin Endocrinol Metab. 51:35–41.
43. Nieschlag E, Lammer U, Freischem CW Langer K, Wickings EJ. 1982 Reproductive function in young fathers and grandfathers. J Clin Endocrinol Metab. 51:675–681.
44. Purifoy FE, Koopmans LH, Mayes DM. 1981 Age differences in serum androgen levels in normal adult males.Hum Biol 53:499–511.
45. Bremner WJ, Prinz PN. 1983 A loss of circadian rhythmicity in blood testosterone levels with ageing in normal men.J Clin Endocrinol Metab. 56:1278–1281.
46. Relationships Between Diabetes Mellitus Type 2 and Male Testosterone Level.Journal of Babylon University/Pure and Applied Sciences/ No.(1)/ Vol.(21): 2013.
47. Zumoff B, Strain GW, Miller LK. Plasma free and non-sex hormone-binding-globulin-bound testosterone are decreased in obese men in proportion to their degree of obesity. J Clin Endocrinol Metab 1990; 71: 929-31 (n).
48. Tishova Y, Kalinchenko SY. Breaking the vicious circle of obesity: the metabolic syndrome and low testosterone by administration of testosterone to a young man with morbid obesity. Arq Bras Endocrinol Metabol 2009; 53(8): 1047-51.
49. Sparrow D, Bosse R , Rowe JW. 1980 .The influence of age, alcohol consumption and body build on gonadal function in men. J Clin Endocrinol Metab . 51: 508–512.
50. Cigarette smoking has a positive and independent effect on testosterone levels. HORMONES 2013, 12(4):567-577.
51. Tong G, Hua X, Zhong Y, and Intensive insulin therapy increases sex hormone-binding globulin in newly diagnosed type 2 diabetic patients. Eur J Endocrinol. 2014;170:237–245.
© The Authors, published by University of Sulaimani, College of Medicine
This work is licensed under a Creative Commons Attribution 4.0 International License.