Serum and Urinary Levels of Pituitary-Gonadal Hormones in Insulin-Dependent and Non-Insulin-Dependent Diabetic Males with and without Neuropathy

Abstract

Diabetic neuropathies were studied in 100 insulin-dependent diabetes mellitus patients, 314 non-insulin-dependent diabetes mellitus patients with and without an objective evidence of neuropathy (age span, 15-80 years; duration of diabetes distributed over 1-33 years), and their age-matched nondiabetic controls. Serum and urinary levels of pituitary-gonadal hormones were evaluated in the diabetic subjects. There were striking results, i.e., a significantly low serum total and serum free (urinary) testosterone level (p < .0005) and a significantly high serum and urinary FSH and LH and serum prolactin level (p < .0005), specifically in the neuropathic diabetic patients, suggesting a series of pathological reactions in the smooth musculature of genital organs characterized by an increase in the interstitial thickness of seminiferous tubules, peritubular and intertubular fibrosis, and tubular sclerosis. Testicular necrosis, probably due to neuropathy, provided an additional aid to confirm these findings. A decrease in semen volume and sperm motility in the diabetic neuropathic patients further suggested the involvement of the entire smooth musculature of the reproductive tract, leading to atonia of the bladder and urethra. Such complications are purely neurogenic. The low serum and urinary testosterone levels and increased serum and urinary FSH and LH and serum prolactin levels in the diabetic men with neuropathy suggest gonadal disorder (hypogonadotropic hypogonadism), which may be due to testicular necrosis and thickening of seminiferous tubules, causing autonomic lesion.

Serum testosterone in males with newly diagnosed type 2 diabetes mellitus and microvascular complications

“…Diabetes mellitus is strongly associated with microvascular complications such as neuropathy, retinopathy and nephropathy resulting in organ and tissue damage and these complications are seen in approximately one-third to one-half of people with the disease (23). There has been a significant correlation between the microvascular complications and the testosterone level of these patients and this association has been strongest with diabetic neuropathy (12,22,24). This study also demonstrated a significant correlation with low Prevalence of hypogonadism is significantly higher in newly diagnosed T2DM patients compared to controls.…”

Steroids in Adult Men With Type 1 Diabetes

“…However, calculated free testosterone may be a better indicator of the free fraction than the free testosterone index, and calculated free testosterone indicates that the difference with nondiabetic men is ϳ10% (24). Hypogonadism was previously shown to be associated with neuropathy (15) and with erectile dysfunction in men with type 1 diabetes (14). Estrone levels were higher in men with diabetes than in control subjects.…”

“…Several factors, such as insulin treatment, insulin resistance, glucose levels, presence of complications such as neuropathy or retinopathy, age, and sex, are likely to be involved in the explanation of the variation of the results between the different publications. In most studies, testosterone levels did not differ between type 1 diabetes and control subjects (2,3,5,6), except in patients with neuropathy (15) or erectile dysfunction (14) and in adolescents (4), who all had lower levels of total testosterone. Because sex hormonebinding globulin (SHBG) levels are often increased, free testosterone levels may be lower in type 1 diabetes (5,11,12,18).…”

“…Besides the well-known risk factors such as diabetes duration, hyperglycemia, hypertension, and hyperlipidemia (1), steroids may also be involved in the development of micro-and macrovascular complications. However, the data about steroid levels presented in the literature are not unequivocal (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17). Several factors, such as insulin treatment, insulin resistance, glucose levels, presence of complications such as neuropathy or retinopathy, age, and sex, are likely to be involved in the explanation of the variation of the results between the different publications.…”

Peripheral insulin-like factor 3 concentrations are reduced in men with type 2 diabetes mellitus: effect of glycemic control and visceral adiposity on Leydig cell function

“…Several studies investigating the hypothalamic-pituitary-gonadal (HPG) axis in T2DM gave conflicting results. Indeed, either hypo-or hypergonadotropic hypogonadism has been reported (2,(8)(9)(10). A recent study demonstrated an association between insulin resistance and a primitive alteration in Leydig cell function in men with various degrees of insulin resistance (11).…”