Effects of treatment for diabetes mellitus on testosterone concentrations: A systematic review

Abstract

Background: Low testosterone levels are frequently present in men with obesity and insulin resistance. Currently available treatment options (testosterone replacement therapy or lifestyle changes) hold possible risks or are insufficient. Since low testosterone levels are closely related to obesity and type 2 diabetes, treatment modalities for these conditions could result into improvement of testosterone levels. Objectives:To summarize the available evidence on the effects of traditional and recent treatment modalities for diabetes mellitus on testosterone levels and androgendeficiency-related signs and symptoms. Materials and methods:PubMed was searched from the year 2000 till present using MESH terms: "hypogonadism," "testosterone," "testosterone deficiency," "functional hypogonadism," and the different classes of medications. Studies with observational and experimental designs on humans that evaluated the effect of antidiabetic medications on gonadotropins and testosterone were eligible for inclusion.Results: Current available data show no or only limited improvement on testosterone levels with the classic antidiabetic drugs. Studies with GLP1-receptor analogues show beneficial effects on both body weight and testosterone levels in men with low testosterone levels and obesity with or without type 2 diabetes. However, data are limited to small and heterogeneous study groups and only few studies report data about impact on androgen-deficiency-related signs and symptoms. Discussion and conclusion:With the recent advances in the knowledge of the pathophysiological pathways in obesity, there is an enormous progress in the development of medications for obesity and type 2 diabetes. Newer incretin-based agents have a great potential for the treatment of functional hypogonadism due to obesity since they show promising weight reducing results. However, before the use of GLP1-receptor analogues can be suggested to treat functional hypogonadism, further studies are needed.

Evaluation of the effect of testosterone replacement therapy with a transdermal testosterone on glycemic control in men with type 2 diabetes mellitus

“…По данным нашего исследования, не было получено статистически значимых различий в применяемой ССТ между группами пациентов с устранением или персистенцией гипогонадизма. Оценке влияния различных групп ССТ в отношении выработки тестостерона посвящено небольшое число работ (14 исследований), объединенных в систематической обзор [14]. Выводы данного обзора согласуются с нашими результатами и говорят об отсутствии значимого влияния классических сахароснижающих препаратов на выработку тестостерона, однако указывают на некоторые преимущества новых групп препаратов, в частности агонистов рецептора ГПП-1 (арГПП-1).…”

“…Вопрос влияния ССТ и коррекции образа жизни на устранение гипогонадизма у мужчин с СД2 изучен слабо. В литературе присутствуют лишь единичные работы, оценивающие воздействие разных групп сахароснижающих препаратов на эндогенную продукцию тестостерона, при этом в ряде случаев -на животных моделях, а также малых выборках [14][15][16], что обуславливает необходимость проведения дальнейших исследований.…”

Not only a matter of glucose: The andrological consequences of diabetes mellitus

“…On the other hand, antidiabetic drugs cause negligible improvement on circulating testosterone, if any. However, promising results are available on the effectiveness of newer incretin‐based agents treating functional hypogonadism 4 . Besides medications, several studies confirm that weight loss by dieting or physical activity is able to improve both metabolic profile and testosterone serum levels 5 .…”

“…However, promising results are available on the effectiveness of newer incretin-based agents treating functional hypogonadism. 4 Besides medications, several studies confirm that weight loss by dieting or physical activity is able to improve both metabolic profile and testosterone serum levels. 5 Both metabolic surgery 6 and ketogenic diet 7 could improve testosterone serum levels alongside body weight reduction and metabolic homeostasis improvement.…”