Low testosterone and diabetes

[Slammr (imported)]

This came to me in an email from a health services I have.

Andrew S. Ross, MD

Medical Director

Interactive Health Solutions

By Megan Rauscher

NEW YORK (Reuters Health) - Men with type 2 diabetes or the metabolic syndrome, or both, are prone to have low testosterone levels. If so, testosterone replacement therapy with a gel applied to the skin may improve their response to insulin and their sexual function, according to the results of a new clinical trial.

Testosterone levels fall if testicular function is subnormal, a condition termed hypogonadism. "Consideration should be given to screening type 2 diabetic and metabolic syndrome patients for hypogonadism," Dr. T. Hugh Jones told the Endocrine Society's annual meeting in San Francisco this week.

Jones, of Barnsley Hospital and the University of Sheffield in the UK, and colleagues tested the effect of a testosterone gel (Tostran) on insulin resistance and symptoms of hypogonadism in 221 men with low testosterone levels.

One average, the men were 60 years age with a body mass index of 32, in the obese range. Eighty percent had metabolic syndrome, 64 percent had type 2 diabetes, and 44 percent had both. They were randomly allocated to use the testosterone gel daily or a matching placebo gel.

The study showed a statistically significant improvement in insulin sensitivity in testosterone-treated men at 6 and 12 months, Jones reported.

Testosterone therapy also led to a significant improvement in the score on a standard assessment of erectile function after 6 and 12 months.

Adverse events were similar in the two groups. Skin-related problems were the most commonly reported adverse events, experienced by 19 (17 percent) placebo-treated and 27 (25 percent) testosterone-treated men.

"These data tell us that replacement therapy for low testosterone in hypogonadal males not only improves sexual function but, more importantly, can also have an impact on insulin sensitivity," Jones said. "Long-term improvements in insulin resistance may help to improve cardiovascular and other diabetes complications and improve quality of life in this at-risk population."

"Awareness of the problems caused by low testosterone is becoming more widespread and its connection to health issues like diabetes continues to become increasingly apparent," he added. "As the incidence of hypogonadism continues to grow along with the aging population, we need to ... implement a more rigorous screening program, particularly in men with type 2 diabetes."

The study was sponsored by ProStrakan, with US headquarters in Bedminster, New Jersey, makers of Tostran (also marketed as Fortigel, Tostrex and Itnogen).

[radar (imported)]

Very interesting, Slammr. I've been trying to convince my endocrinologist to put me on HRT for some time, and this may be useful in convincing him. He won't do it, not because my levels aren't low (I'm running around 165, which is next to nothing, as far as I'm concerned), but because there's some other enzyme they measured that's also quite low. This enzyme is what binds with testosterone and takes it out of circulation, according to him, so the net result is that free testosterone is probably still in the "normal" range. You'd never know it from my libido, but what the hell...

[jemagirl (imported)]

Very interesting, Slammr. I've been trying to convince my endocrinologist to put me on HRT for some time, and this may be useful in convincing him. He won't do it, not because my levels aren't low (I'm running around 165, which is next to nothing, as far as I'm concerned), but because there's some other enzyme they measured that's also quite low. This enzyme is what binds with testosterone and takes it out of circulation, according to him, so the net result is that free testosterone is probably still in the "normal" range. You'd never know it from my libido, but what the hell...

My advice is at the very least to get a second opinion and if at all possible a different endocrinologist.

[kristoff]

Very interesting, Slammr. I've been trying to convince my endocrinologist to put me on HRT for some time, and this may be useful in convincing him. He won't do it, not because my levels aren't low (I'm running around 165, which is next to nothing, as far as I'm concerned), but because there's some other enzyme they measured that's also quite low. This enzyme is what binds with testosterone and takes it out of circulation, according to him, so the net result is that free testosterone is probably still in the "normal" range. You'd never know it from my libido, but what the hell...

Off hand, I would suggest a second opinion. I'm not an endocrinologist obviously, but I would be suspicious of such an opinion.

[radar (imported)]

Off hand, I would suggest a second opinion. I'm not an endocrinologist obviously, but I would be suspicious of such an opinion.

I'm coming to that conclusion myself. I've suffered from depression for nearly 10 years now, and have a terrible time controlling my weight, not to mention that I haven't had a spontaneous erection in years. I can still get it up, but can only sustain it with constant stimulation. Good thing I'm not married...:-\

[Paolo]

Research indicates it's sort of a "chicken and the egg" thing -

Does low T cause Type-2 diabetes in adult men, or does diabetes result in low T.?

Me, I had low T for years before diabetes hit. But I was overweight, too, and not all that active. Poor diet, etc. But was I so sedentary and gaining weight, even though I tried to be careful of what I ate, because I was tired from low T.?

Moot point now, though, although a lot of problems have cleared up since I lost weight and got my BG under control.

[cordonone (imported)]

Very interesting, Slammr. I've been trying to convince my endocrinologist to put me on HRT for some time, and this may be useful in convincing him. He won't do it, not because my levels aren't low (I'm running around 165, which is next to nothing, as far as I'm concerned), but because there's some other enzyme they measured that's also quite low. This enzyme is what binds with testosterone and takes it out of circulation, according to him, so the net result is that free testosterone is probably still in the "normal" range. You'd never know it from my libido, but what the hell...

I'm not a doctor, but I would suggest that you get a second opinion from another endo. I've been on HRT since a very young age, have been treated by several excellent physicians and have done countless hours of self-interested research; from all I've learned and know, what you have described doesn't make sense, as it is presented.

First of all, it's a matter of measurement, not guesswork, whether "

free testosterone is probably still in the

'normal' range." It either is or it isn't.

Second, total testosterone of 165, assuming we're both thinking about the same measurement system, is outside the reference range for any adult age band.

So, unless you're misunderstanding what your doctor is telling you or you're leaving something out, it sounds like something is wrong here.

[JesusA (imported)]

Second, total testosterone of 165, assuming we're both thinking about the same measurement system, is outside the reference range for any adult age band.

Since my GP knows of my research on the voluntary eunuch community (and has read all of the articles to date), he suggested that he ask for a T measurement as part of the blood draw for my last physical. The report back from the lab gave a normal "reference range" for "free and total testosterone" of 165 – 830 NG/DL.

[radar (imported)]

So that's the "normal" range now? Seems to me they keep lowering it. A little history: When I first began pursuing this issue with my endocrinologist, my T count was 265, and he was willing to prescribe. But the insurance company wouldn't pay for the supplements because the low boundary of "normal" was then defined by them as 250 ng/dl.

It then fell to 220, and for a brief period I was using a low dose of Androgel, and it helped some, bringing the count up to about 330, but that only really served to help lessen the depression. My doctor wouldn't prescribe a higher dose I believe because he was terribly afraid of exacerbating any latent prostate cancer I might have, this despite PSA readings in the 0.2 range. For him to prescribe the stuff I had to get examined by my urologist every 6 months.

Then I changed jobs, and the new insurance company wouldn't pay for it until it dropped below their "normal" boundary of 200. When I next got a T check, it had dropped to 165, and the rest of it I've already told. What bothers me about all of this is that it seems the insurance companies are engaged in a program of continually lowering the limit at which they will pay for the supplement. Given their continued willingness to pay for women's post menopausal estrogen supplements, this strikes me as sex discrimination, done in this case partly to control costs and partly because of the bad press constantly given to steroids, and because they figure men won't protest as much.

For whatever reason, it seems to me that the medical establishment is refusing to consider either side of the testosterone issue. They treat men who seek castration as a way of reducing libido as mental defectives, and they treat men who would like to regain their lost libido and energy via testosterone supplements as inconsequential.

I will seek out another endocrinologist, though, and make an appointment. Does anyone have any suggestions as to how to pre-screen these people to make sure they don't reject supplementation out of hand? I've found that they aren't always forthcoming when asked directly over the phone. They usually wait until they've milked you for at least one office visit fee before saying "no".

[kristoff]

Since my GP knows of my research on the voluntary eunuch community (and has read all of the articles to date), he suggested that he ask for a T measurement as part of the blood draw for my last physical. The report back from the lab gave a normal "reference range" for "free and total testosterone" of 165 – 830 NG/DL.

Keep in mind that the norms are usually established by age ranges, too. The norms generally drop with age.