Diabetes and low Testosterone

Medically reviewed by Pat F. Bass III, MD, MPH

 

 

 

 

 

 

If you’re over 45, male, have type 2 diabetes, and are having trouble with your sex life, the problem could be low testosterone.

“There is increasing evidence that low testosterone is associated with obesity, high blood pressure, high cholesterol, and diabetes,” says David Fenig, MD, associate director of male fertility and sexuality at Chesapeake Urology Associates in Baltimore, Md. “In fact, recent studies have suggested that low testosterone is present in up to one-third of men with type 2 diabetes, and that men who are over 45 are twice as likely to be diagnosed with low testosterone.”

How Do You Know if You Have Low Testosterone?

Testosterone is the main male sex hormone, and it’s important for maintaining normal sexual functioning, muscle strength, mood, and energy level. If you’re experiencing any of the following symptoms, especially if you have type 2 diabetes, you should see your doctor:

  • Sexual problems. Low testosterone can cause you to have a low sex drive and trouble maintaining an erection. According to the American Diabetes Association (ADA), about 70 percent of men with low testosterone levels report erectile dysfunction and 63 percent report diminished sex drive.
  • Energy problems. You may feel tired and find yourself falling asleep early in the evening.
  • Strength problems. You may notice a decrease in your muscle mass, endurance, or performance at work or in sports.
  • Emotional problems. Ask yourself if you feel abnormally sad or have lost interest in life.

If you recognize these symptoms, ask your doctor to check your testosterone level with a simple blood test.

What Causes Low Testosterone in Men With Type 2 Diabetes?

“It’s not clear whether one causes the other,” explains Dr. Fenig. “Research shows that men with low testosterone are more likely to develop type 2 diabetes. Testosterone enhances the body’s response to insulin, so it’s possible that low testosterone can cause a poor response to insulin, and diabetes is a disease in which the body does not produce or properly use insulin.”

“On the other hand, we know testosterone is made in the testicles in response to a hormone produced in the pituitary gland called luteinizing hormone. Diabetes may affect the pituitary gland, causing it to decrease the amount of luteinizing hormone it produces.” says Fenig. “There are also other factors that may be involved since it’s well documented that obesity is associated with insulin resistance, diabetes, and low testosterone.” In one recent study of young men with type 2 diabetes, 58 percent were found to have low testosterone levels and all of these men were obese.

Low Testosterone Prevention and Management

The best thing you can do to manage or prevent low testosterone is to take care of your type 2 diabetes and get your weight under control. “Weight loss, diet, and exercise, which are important in managing type 2 diabetes, can also help manage testosterone levels,” advises Fenig.

How frequently you get your testosterone level checked will depend on your symptoms. “I would suggest having your testosterone level checked if you’re feeling fatigued or have decreased energy or libido,” says Fenig. If you do have low testosterone, your doctor can prescribe one of several treatment options including testosterone replacement in a gel, patch, or injection. You cannot take testosterone if you have prostate cancer or male breast cancer. Your doctor may also refer you to an urologist or endocrinologist who specializes in treating low testosterone.

Raising Awareness of Low Testosterone

Low testosterone in men with type 2 diabetes is a significant concern because it affects men’s sexual functioning and reproductive capacity. Twelve million American men are diagnosed with diabetes and, according to a survey released by the American Diabetes Association, most men and their wives are unaware of the connection between diabetes and low testosterone. They may be frustrated by low energy, fatigue, and sexual problems but fail to discuss these issues with their doctors. The survey found that 60 percent of the men felt they needed more information to help them manage their diabetes.

The ADA estimates that as many as 13 million men have low testosterone levels — 90 percent of whom go untreated. If you have type 2 diabetes, especially if you’re overweight and over 45, you need to be aware of the symptoms of low testosterone. Talk to your doctor about it and get informed.

DSK comments: Scientists initially believed low testosterone caused insulin resistance, and obesity which led to Diabetes 2 diabetes and people so afflicted should be treated with Testosterone.  Scientists are now changing their position realizing that obesity may inhibit the pituitary function and lead to low testosterone.  Rather than recommending treatment with Testosterone for all patients, dietary therapy to promote weight loss has been used.  Both men and women may have dysmetabolic syndrome characterized by increase in abdominal girth with 2 of the following Diabetes type 2, high blood pressure, and  abnormal lipids.  Women who have this may have polycystoic ovary disease and men low testosterone.  This syndrome is dramatically improved with weight loss.  The low testosterone may be a marker for disease rather than its cause.

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