Testosterone therapy improves cholesterol, HbA1c, body composition in men with type 2 diabetes

Men with type 2 diabetes and low testosterone treated with 12 months of testosterone therapy saw improvements in lipid profiles, glycemic control and metabolic profiles in addition to increased testosterone levels, according to study findings presented at the 51st European Association for the Study of the Diabetes Annual Meeting.

“We know that the prevalence for low testosterone levels are very high in male patients with type 2 diabetes,” Michal Rabijewski, MD, PhD, of the department of internal diseases, diabetology and endocrinology at the Medical University of Warsaw, Poland, said during a presentation. “It is about 40%. These low testosterone levels are associated with metabolic disorders and also ... with poor glycemic control and higher [HbA1c]. So, it seems very important to look for not only the signs and symptoms of hypogonadism, but mainly for symptoms of low testosterone in our diabetic patients.”

Rabijewski and Pawel Pitkiewicz, MD, PhD, of the department of internal diseases, diabetology and endocrinology at the Medical University of Warsaw, analyzed data from 102 men with newly diagnosed type 2 diabetes aged 53 to 68 years, with a BMI between 27.5 kg/m² and 38.5 kg/m². Researchers assessed total testosterone and free testosterone, lipid levels, HbA1c, BMI, waist-to-hip ratio and waist circumference.

All men in the cohort had total testosterone levels of 12 nmol/L or less and free testosterone levels of 0.25 nmol/L or less.

“[The men had] low testosterone levels, but did not present any clinical signs or symptoms of hypogonadism.” Rabijewski said. “So according to the guidelines, we should not be treating [with testosterone therapy].”

Within the cohort, 64 men were assigned to either diet, antidiabetes therapy and testosterone therapy (testosterone enanthate, 200 mg every 2 weeks) for 12 months; 38 men were assigned to diet and antidiabetes therapy as a control group. For the treatment group, researchers controlled prostate volume and prostate-specific antigen (PSA).

The study was not randomized and was open-label, Rabijewski said, with testosterone levels measured in the morning.

Both groups experienced significant improvements in lipid profile after 12 months; however, the testosterone group experienced greater decreases in both total cholesterol (256.4 mg/dL to 221.8 mg/dL vs. 249.4 mg/dL to 238.2 mg/dL) and LDL cholesterol (179.3 mg/dL to 147.4 mg/dL vs. 175.5 mg/dL to 163.3 mg/dL). The testosterone group also experienced a greater decrease in HbA1c over 12 months (8.3% to 7.2% vs. 8.4% to 7.6%).

Waist-to-hip ratio measurements and waist circumference measurements decreased for both groups, but changes in the testosterone group were greater.

“In the testosterone group, this positive effect was more expressed,” Rabijewski said. “In HbA1c, we observed an additional, very positive effect of testosterone replacement therapy.”

BMI decreased for both groups, but the changes between groups were not significant, Rabijewski said.

PSA and prostate volume did not change during treatment, Rabijewski said, and the type of antidiabetes therapy did not affect lipid levels, HbA1c or body composition measurements.

“This treatment with testosterone was very safe, and routine testosterone measurement and looking for hypogonadism — both clinical and nonclinical — should be taken under consideration in all diabetic men,” Rabijewski said. – by Regina Schaffer

Reference:

Rabijewski, M, Pitkiewicz, P. Abstract 87. Presented at: 51st EASD Annual Meeting; Sept. 14-18, 2015; Stockholm.

Disclosure: Rabijewski reports no relevant financial disclosures.