Healio
Healio
November 09, 2011
1 min read
Save

Use of routine testosterone unjustified in men with diabetes

TORONTO — Given the lack of evidence from prospective, randomized trials, testosterone should not be routinely administered among men with type 2 diabetes and low testosterone to improve metabolic parameters. Additionally, in the absence of solid evidence, weight loss should be recommended to improve metabolic parameters and decrease HbA1c.

An advocate for testosterone therapy debated a proponent for alternatives to testosterone therapy here at the Annual Meeting of the Canadian Diabetes Association/Canadian Society of Endocrinology and Metabolism.

Richard Bebb, MD, a consultant endocrinologist at St. Paul’s Hospital in Vancouver, British Columbia, said weight loss should be recommended as an alternative treatment in these patients to improve metabolic parameters and improve HbA1c, noting that there is a “vicious circle” in which hypogonadism causes weight gain, and weight gain exacerbates hypogonadism.

Moreover, Bebb said insulin resistance should not be regarded as an endpoint in clinical trials examining this question, for it is a surrogate marker.

Ronald M. Goldenberg, MD, a consultant endocrinologist at North York General Hospital in Toronto, said several observational studies demonstrated that testosterone replacement improved metabolic features in hypogonadal men with type 2 diabetes.

A 52-week study found that men with type 2 diabetes and low testosterone experienced significantly greater improvement in glycemic control and a reversal of metabolic syndrome features with diet and exercise, as well as testosterone therapy, compared with men treated with diet and exercise alone.

“If patients have signs and symptoms of hypogonadism, we treat them,” Goldenberg said, noting that there is a high prevalence of hypogonadism in men with type 2 diabetes.

For more information:

  • Bebb R. #44.
  • Goldenberg R. #44. Both presented at: Annual Meeting of the Canadian Diabetes Association/Canadian Society of Endocrinology and Metabolism; Oct. 26-29, 2011; Toronto.
  • Heufelder AE. J Androl. 2009;30:726-733.

Disclosure: Dr. Goldenberg receives honoraria and consultant fees from Abbott Canada.

PERSPECTIVE

We don’t have long-term randomized controlled trials, and we do need them before recommending testosterone replacement in men with type 2 diabetes. At this time, weight loss is a much safer means to achieve the goals rather than using testosterone.

– Ivy Fettes, PhD, MD, FRCPC
Professor, Department of Medicine, University of Toronto;
Director, Division of Endocrinology, Sunnybrook Health Sciences Centre, Toronto

Twitter Follow EndocrineToday.com on Twitter.