The purpose of the Nebido® publications portal (NPP) is to present testosterone related research, in an easily searchable and navigable interface, to health professionals who search for scientific information on hypogonadism, testosterone replacement therapy and testosterone related health issues.
Long-term testosterone therapy in hypogonadal men with T2DM brings results in meaningful and sustained improvements of glycemic control with parallel reductions in body weight and waist circumference. These effects are likely mediated by the increase in lean body mass, which is always achieved by T therapy, as well as improvements in energy and motivation which may contribute to adopting a healthier lifestyle.
As recommended by various guidelines, testosterone should be measured in men with T2DM. If hypogonadism is diagnosed, adequate long-term testosterone therapy can have a substantial positive impact on ameliorating T2DM and possibly even result in remission of T2DM.
Int J Clin Pract. 2017 Nov;71(11). doi: 10.1111/ijcp.12995. Epub 2017 Oct 5.
The interpretation of a testosterone level found to be low on a sample taken in the morning around 09.00, should ideally be followed by LH measurement in order to rule out secondary hypogonadism. Measurement of SHBG makes it possible to calculate free T levels.
Interdisciplinary management of hypogonadism is important due to its high prevalence and diverse presenting symptoms. A better understanding of hypogonadism and T treatment across primary and secondary care has the potential to yield significant morbidity and mortality benefits for patients.
Testosterone therapy for up to 8 years results in progressive, continuous and sustained reduction in body weight, waist circumference and BMI, regardless of obesity grade and age. Improvements in obesity parameters are accompanied by significant improvements in glycemic control (fasting glucose and HbA1c), lipids (total cholesterol, LDL, HDL, triglycerides and total cholesterol:HDL ratio), liver transaminases, inflammation, blood pressure (both systolic and diastolic) and quality of life, regardless of obesity grade and age.
Treating obese hypogonadal men with testosterone for 8 years is safe. Elevations in PSA and hematocrit stayed within normal ranges, and the incidence of prostate cancer is lower than expected from the prostate cancer incidence reported in the general population of men not treated with testosterone. Using testosterone therapy as a mode of obesity treatment may result in greater beneficial effects on body composition than diet and/or drug induced weight loss.
There is a high level of evidence that hypogonadism is associated with increased all-cause mortality and reduced quality of life. There is a considerable body of credible evidence over several decades that testosterone therapy according to expert guidelines is safe and efficacious for men suffering from confirmed testosterone deficiency. There is emerging evidence that testosterone therapy in such cases of established hypogonadism may reduce all-cause mortality. Recent studies suggesting that testosterone therapy may increase cardiovascular risk are severely flawed and do not exclude the possibility that increased risk is related to hypogonadism and not the treatment.
This controlled study shows that testosterone treatment for 24 weeks in hypogonadal men with type 2 diabetes has insulin-sensitizing and anti-inflammatory effects in addition to a reduction in adiposity and an increase in the lean body mass. The increase in the expression of genes related to insulin signal transduction and the suppression of genes interfering with the action of insulin probably account for this insulin sensitizing effect.
In addition, there was also an improvement in sexual function.
Testosterone treatment for 1 year in men aged 65 years and older significantly improves:
Sexual desire, erectile function, and sexual activity.
Basic activities of daily living and walking speed.
Mood and depressive symptoms.
A greater increase in testosterone levels during treatment is associated with a greater increase in sexual activity and a greater reduction in fatigue.
Men in the testosterone group were more likely than those in the placebo group to report that their sexual desire, perception of walking ability and energy had improved.
The rates of adverse events were similar in the testosterone and placebo groups. During the follow-up year, there were 8 myocardial infarctions in the placebo group compared to 1 in the testosterone group.