Testosterone Replacement Benefits Men With Type 2 Diabetes

HAMBURG — Testosterone replacement therapy was associated with significant reductions in A1c at 1 and 2 years among men with type 2 diabetes, a multinational audit shows.

"If you have a patient with type 2 diabetes, sexual dysfunction, or fatigue, please consider checking their testosterone level. And if they fulfill criteria for testosterone deficiency and have had their [prostate-specific antigen] checked, consider a trial of treatment and follow them," study lead author T. Hugh Jones, MD, consultant physician and endocrinologist at Barnsley Hospital NHS Foundation Trust, Barnsley, United Kingdom advised, speaking with Medscape Medical News.

Jones also urges clinicians worldwide to enter their patients' data into the ABCD Testosterone Audit, which aims to identify long-term outcomes and predictors of response to testosterone replacement therapy.

Jones, who is also professor of andrology at the University of Sheffield, presented the preliminary data analysis at the annual meeting of the European Association for the Study of Diabetes.

Thus far, a total of 428 men with type 2 diabetes and hypogonadism are entered into the audit, from 34 centers in eight countries: the United Kingdom, Germany, Canada, Brazil, South Africa, New Zealand, Malaysia, and Vietnam. Among 121 of the men at 12 months, there was a drop in A1c from a baseline level of 71.27 mmol/mol (8.7%) to 61.26 mmol/mol (7.8%). Among 104 men at 24 months, the drop was from 71.4 mmol/mol (8.7%) to 55.97 mmol/mol (7.3%). Both decreases were significant (P < .001).

Prior data from Jones' group showed that about 40% of men with type 2 diabetes have symptomatic testosterone deficiency . Testosterone deficiency is also associated with adverse effects on cardiovascular risk factors, bone health, muscle strength, sexual function, and psychological well-being, yet it is often overlooked, Jones noted.

"It's not typically measured in routine clinical practice… Deficiency is very common, but a lot of practitioners don't treat it and don't ask about it. But in fact, treatment has very significant benefits for patients… We know from sildenafil (Viagra) studies that 60 percent of people who didn't respond were testosterone deficient. After being given testosterone, they converted to Viagra responders," he noted.

Regarding safety concerns, the recent findings from the TRAVERSE study, in which about 70% of participants had type 2 diabetes, demonstrated no increased cardiovascular risk. There was also no association with prostate cancer, although it's important to monitor prostate-specific antigen in patients for the first year on testosterone replacement, Jones said.

Asked to comment, endocrinologist Bradley D. Anawalt, MD, chief of medicine at the University of Washington Medical Center, Seattle, told Medscape Medical News, "This 'worldwide survey' confirms many studies from around the world over the past 20 years… [T]he association is due to 'reverse causation,' in that diabetes type 2 and obesity lower testosterone concentrations. Weight loss of 5%-10% may raise testosterone concentrations in men with high body mass indices, large waist circumferences, and low blood testosterone concentrations."

At the same time, Anawalt pointed to data suggesting that "[t]reatment of androgen deficiency may facilitate lifestyle measures in men with high [body mass indexes] and high risk of type 2 diabetes to prevent, or more likely delay, the development of type 2 diabetes."

However, both Jones and Anawalt emphasized that testosterone therapy would not be expected to affect blood glucose levels or any other cardiometabolic parameters in men who are not testosterone deficient, regardless of diabetes status.

"It's important when you give testosterone to replace it to the normal level. Adequate treatment gives the greatest benefit," Jones said.

As more centers contribute data to the ABCD audit, Jones anticipates collecting clinical practice data on a variety of clinical parameters, including complications, total insulin dose, kidney function, and eventually cardiovascular outcomes.

In the meantime, he said, giving testosterone replacement to men with deficiency can be very rewarding for many reasons. "People feel better. Individual patients come back and say 'thank you doctor, you've given me my life back.' It's not often you get that. And the compliance is excellent."

Jones is a speaker for, advisory board member for, and/or travel grant recipient of Besins Healthcare, Grunenthal, and Simple Pharma. Anawalt has no disclosures.

European Association for the Study of Diabetes 2023 Annual Meeting: Abstract 704. Presented October 3, 2023.

Miriam E. Tucker is a freelance journalist based in the Washington, DC, area. She is a regular contributor to Medscape, with other work appearing in the Washington Post, NPR's Shots blog, and Diabetes Forecast magazine. She is on Twitter @MiriamETucker.

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Cite this: Testosterone Replacement Benefits Men With Type 2 Diabetes - Medscape - Oct 17, 2023.