Sex steroids and glucose metabolism

Abstract

Testosterone levels are lower in men with metabolic syndrome and type 2 diabetes mellitus (T2DM) and also predict the onset of these adverse metabolic states. Body composition (body mass index, waist circumference) is an important mediator of this relationship. Sex hormone binding globulin is also inversely associated with insulin resistance and T2DM but the data regarding estrogen are inconsistent. Clinical models of androgen deficiency including Klinefelter's syndrome and androgen deprivation therapy in the treatment of advanced prostate cancer confirm the association between androgens and glucose status. Experimental manipulation of the insulin/glucose milieu and suppression of endogenous testicular function suggests the relationship between androgens and insulin sensitivity is bidirectional. Androgen therapy in men without diabetes is not able to differentiate the effect on insulin resistance from that on fat mass, in particular visceral adiposity. Similarly, several small clinical studies have examined the efficacy of exogenous testosterone in men with T2DM, however, the role of androgens, independent of body composition, in modifying insulin resistance is uncertain.

Hypogonadism and associated risk factors in male patients with type 2 diabetes mellitus attending the diabetic clinic of Tikur Anbessa Specialized Teaching Hospital, Addis Ababa, Ethiopia

“…22 Hyperglycaemia in turn has an effect on testicular microvasculature and results in a decrease in TT level. 32 Our finding regarding FBG as a risk factor was not supported by much of the literature but is in line with studies conducted in Ghana and Korea. This can be justified based on the fact that hyperglycaemia has an effect on testicular microvasculature by altering Leydig cell function, directly causing primary hypogonadism.…”

“…Moreover, if glucose is not reaching the cells because of insulin insensitivity, there will not be enough energy generated for the various metabolic processes involved in maintaining testosterone levels. 23,32 The present study has several limitations. One of these was the use of a small, non-probability sampling method and the selection of study subjects from tertiary referral outpatient services, where most of the patients had many complications and numerous comorbidities.…”

The Prevalence and the Risk Factors of Testosterone Deficiency in Newly Diagnosed and Previously Known Type 2 Diabetic Men

“…Although it has been well known that testosterone deficiency is closely related to T2DM [1–3], it is not known whether testosterone deficiency is a cause or a consequence of T2DM or its associated clinical features [21,22]. The hypothesis that testosterone deficiency leads to T2DM is supported by relatively more evidence, including prospective observational cohort studies [23–25], prostate cancer patients receiving androgen deprivation therapy [26], as well as testosterone replacement therapy in hypogonadal T2DM patients [27].…”

“…Although it has been well known that testosterone deficiency is closely related to T2DM [1][2][3], it is not known whether testosterone deficiency is a cause or a consequence of T2DM or its associated clinical features [21,22]. The hypothesis that testosterone deficiency leads to T2DM is supported by relatively more evidence, including prospective observational cohort studies [23][24][25], prostate cancer patients receiving androgen deprivation therapy [26], as well as testosterone replacement Total: all subjects with T2DM The bold form indicates statistical significance, when the 95% confidence interval does not cover the value of the odds ratio BMI = body mass index; CI = confidence interval; HDL = high-density lipoprotein; hsCRP = high-sensitivity C-reactive protein; KDM = previously known T2DM; LDL = low-density lipoprotein; MetS = metabolic syndrome; NDM = newly diagnosed T2DM; NS = not significant; OR = odds ratio; PSA = prostate-specific antigen; SHBG = sex-hormone binding globulin; T2DM = type 2 diabetes mellitus therapy in hypogonadal T2DM patients [27].…”

Androgen Deficiency Disorders

“…261,262 Preliminary studies suggest that testosterone therapy may improve glycemic control and reduce insulin resistance in men with type 2 diabetes, but long-term follow-up data, particularly with respect to cardiovascular outcomes, are not available. 263,264 Testosterone levels generally are normal in men with type 1 diabetes 262 ; low testosterone levels at the time of diagnosis 265 may reflect the suppressive effects of acute systemic illness on the HPT axis. Men with poorly controlled type 1 diabetes have compromised endogenous and GnRH-stimulated LH secretion.…”