According to WebMD, “As many as half of men with diabetes have low testosterone (T) levels. Scientists aren’t sure whether diabetes causes low testosterone, or the other way around.”
Now a team of international researchers led by Paresh Dandona, MD, PhD, has discovered that type 2 diabetes can often be reversed by raising male patients’ testosterone levels. In an 11-year study recently published in the journal Diabetes, Obesity and Metabolism, 356 men with type 2 diabetes and low testosterone in a German urology clinic were given regular diabetes treatment, including self-management training. Half were also given regular injections of testosterone. Researchers reported some impressive results:
• Over one-third (34.3%) of the patients given testosterone injections achieved diabetes remission, meaning an A1C level (a measure of glucose control over the previous two to three months) below 6.5%, for six months without the use of medications.
• Additionally, 46.6% of subjects achieved normal glucose levels with use of diabetes medicines.
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So that means that 80% of participants had normal glucose levels, greatly reducing their risk of diabetes complications. An additional 10% got their A1C below 7%, the usual recommended range for people with diabetes.
In contrast, none of the 178 patients in the control group reduced their glucose levels. (Controls were not chosen at random; they were patients who preferred to avoid the testosterone injections.)
At the beginning, the testosterone group had considerably higher A1C and fasting blood sugars than the control group, and they still had far better results. The testosterone group also had fewer deaths, fewer heart attacks and strokes ,and fewer diabetic complications compared to the controls.
The diabetes-testosterone connection
According to Dandona, “About one-third of adult men living with type 2 diabetes experience low T levels (a condition known as hypogonadism [ hi-po-GO-nad-ism].” His research has confirmed that high blood sugars can block the body’s testosterone production.
It’s a vicious cycle, because men with low testosterone have more insulin resistance compared to men with normal testosterone levels. So their blood sugars will be higher, lowering their testosterone levels even more. Dandona’s research had previously found that testosterone decreased patients’ insulin resistance.
Studies show that the diabetes/testosterone connection involves body fat. According to the British website diabetes.co.uk, men who have normal levels of testosterone tend to deposit fat under the skin (called “subcutaneous” [sub-q-TAIN-ee-us] fat). But men with low testosterone levels deposit fat around the abdominal organs a type of fat known as “visceral” fat).
Visceral fat in the liver and pancreas interferes with insulin production and increases insulin resistance. Visceral fat is also associated with heart disease, Alzheimer’s disease and cancer.
Low testosterone can also cause loss of muscle mass. Active muscles lower blood sugar and improve insulin function. Loss of muscle caused by low testosterone can hinder diabetes control. Dandona found that men in his study lost body fat, but gained an equal amount of weight in muscle on testosterone
Other effects of low testosterone
As you can see in by looking through any men’s magazine, many men buy products that promise to raise their testosterone, because raising testosterone levels can help prevent negative effects such as:
- Erectile dysfunction (ED) — loss of sexual function or interest in sex
- Loss of body hair
- Thinning bones and/or loss of height
- Weight gain
An analysis by cardiologist Hiroaki Kawano, MD, of Nagasaki University, published in the journal Nature found that low testosterone levels contributed to metabolic syndrome — a combination of high blood sugars, high blood pressure, bad cholesterol levels and weight gain. After one year of treatment with testosterone gel, significantly more men in the testosterone-treated group no longer had metabolic syndrome.
Forms of testosterone
Testosterone comes in many forms. You will need to consult with a doctor and get a prescription if you want to try it. Four types of injections are listed on website the Biostation, including some that are less expensive. Dandona prescribes a form of testosterone known as cypionate, which is injected every two weeks.
Testosterone can also be given orally. Pills must be taken twice a day. There are also testosterone gels applied to the skin. Gels need to be applied every day or two, depending on the product. You and your doctor have to monitor your testosterone level to see if the supplements are raising your levels adequately.
Some of these products may be covered by your insurance if you have low testosterone and other symptoms, such as loss of sex drive or decreased muscle mass.
Risks and downsides
Supplemental testosterone can cause side effects. MedicineNet lists the following:
- High blood pressure
- Application site reactions such as itching, blisters and redness (with gels)
- Enlarged prostate gland
- Increased levels of serum prostate specific antigen (PSA) levels, the protein associated with prostate cancer
University of Michigan Health warns: “Testosterone can increase your risk of heart attack, stroke or death.” However, Dandona’s study found that the testosterone group had lower levels of all these things than the controls.
Testosterone sometimes raises patients’ hemoglobin (Hgb) level, which can make their blood too thick. Dandona treated patients with high hemoglobin by sending them to the Red Cross to donate blood, which “solved their problem and helped other people, too.”
Non-prescription ways to raise testosterone
There are also non-drug ways to raise testosterone. An article on Healthline recommends consuming zinc, vitamin D, low-fat milk, shellfish, tuna, egg yolks, beef and beans. Diabetes.co.uk advises that it’s important to stop smoking and moderate alcohol intake.
Exercise raises testosterone levels, especially strength training. Because the stress hormone cortisol lowers testosterone function, relaxation and lowering stress can raise it.
Dandona’s team is seeking funding for a long-term randomized, controlled trial to confirm the value of testosterone as a diabetes treatment. Doctors and patients, however, do not necessarily have to wait.
If you’re interested in testosterone treatment, ask your doctor to check your testosterone level and prescribe some if it’s low. “You may have to convince them,” says Dandona, “because they may not be aware of research on of effect on insulin resistance.” You can show them this article.
Want to learn more about testosterone in diabetes? Read “Men and Low Testosterone.”