Italy: Testosterone replacement therapy was associated with improved metabolic profiles for men with hypogonadism and prediabetes, compared with controls, according to a systematic review published in Andrology. Further testosterone replacement therapy was associated with better triglyceride levels for patients in the treatment cohort, said the researchers from Medical Department, Endocrinology Unit, Azienda Usl, Maggiore-Bellaria Hospital, Bologna, Italy
Type 2 diabetes mellitus and prediabetes are related to reduced circulating testosterone levels. 20%–30% of prediabetic and diabetic subjects show T deficiency, while T supplementation to hypogonadal subjects improves body composition and glucose levels, as shown in the meta-analysis.
So, a hypothesis could state that “T replacement therapy (TRT) confers benefits in hypogonadal men with diabetes or prediabetes.”
The present systematic review researched the above background to the core, as there needs to be more data on the conflicting role of TRT in such patients.
The researchers did a comprehensive systematic review and also included 4682 patients seeking medical care for sexual dysfunction at the University of Florence were also considered in the study.
The study results could be summarised as follows:
Patients with impaired fasting glucose had three nmol/L lower total testosterone levels than controls.
An impaired fasting glucose had a 1.8-fold increased risk of hypogonadism than those with normal glucose levels.
The best predictors of reduced total testosterone levels were waist circumference and body mass index.
Secondary hypogonadism was twice higher in subjects with impaired fasting glucose than in the general population.
TRT improved body composition, insulin resistance, and glucose profile. This was observed in impaired fasting glucose and type 2 diabetes. However, the effect on weight, lipid, and sexual function was less evident.
The researchers discussed that weight loss and physical activities improve both metabolic profile and testosterone levels.
We suggest combining TRT and lifestyle modifications in symptomatic hypogonadal men to motivate patients better for performing physical activity, as it results in not only weight loss but also metabolic profile and sexual function improvement.
Further studies are warranted in this context.
Concluding further, metabolic derangements by significantly lower T circulating levels. This can be improved by TRT. The weight loss and physical activities improve both metabolic profile and T levels, and hence combined approach is worthwhile.
Further reading:
https://onlinelibrary.wiley.com/doi/10.1111/andr.13367