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Study: Testosterone Replacement Ineffective in Men with Type 2 Diabetes

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In 2013, a study published in JAMA Internal Medicine reported that prescriptions for testosterone therapy products increased threefold between 2001 and 2011. Among all new users of the drugs, more than a quarter had not had their testosterone levels checked before starting the treatment.

Recent studies have raised questions as to whether men should be so quick to start testosterone therapy, particularly if they haven’t been diagnosed with low testosterone, or hypogonadism. Now, a new study shows that even when men do have such a diagnosis, testosterone therapy may still not help with symptoms, particularly if the men have type 2 diabetes.

Study Shows Testosterone Doesn’t Help Men with Type 2 Diabetes

The study appeared in The Journal of Clinical Endocrinology & Metabolism. Researchers looked at 88 men between the ages of 35 and 70 years, who had type 2 diabetes. All of the men had erectile dysfunction, mild to moderate symptoms of aging, and a total testosterone level of less than 346 ng/dl. (The average level is 679 ng/dL.)

Researchers then randomly assigned these men to 40 weeks of either intramuscular testosterone replacement therapy or placebo. Results showed the following:

• Testosterone treatment did not substantially improve symptoms of aging.
• Testosterone treatment did not substantially improve sexual desire.
• There was no significant difference between the beginning and end of the study in erectile function in either group.

Researchers concluded that in this trial, “testosterone treatment did not substantially improve constitutional or sexual symptoms in obese, aging men with T2D [type 2 diabetes] with mild to moderate symptoms and modest reduction in testosterone levels typical for the vast majority of such men.”

Conflicting Study Results

Men with type 2 diabetes often have low testosterone levels. A 2013 study found that low testosterone levels could help predict if men would develop insulin resistance or type 2 diabetes. An earlier 2010 study also found that as men gained weight, their testosterone levels decreased.

It therefore seemed logical that testosterone replacement might help these men, but this study didn’t find that to be true. An earlier 2011 study found the opposite, however. When researchers gave men who had hypogonadism and type 2 diabetes transdermal testosterone gel for 12 months, they experienced improvements in total and LDL cholesterol, libido, and sexual function.

Drugs Linked with Increase in Cardiovascular Events

The conflicting results show that we need more research on these drugs. This past year, other studies came to light that found men taking them had an increased risk of heart attack and stroke. One published in PLoS One, for instance, found that in older men, and in younger men with pre-existing diagnosed heart disease, taking testosterone therapy doubled risk of heart attack.

In January 2014, the FDA issued a drug safety communication stating that based on new scientific evidence, they were evaluating the risks of stroke, heart attack, and death in men taking testosterone products. They recently scheduled an advisory committee meeting for September 2014, to further discuss the potential cardiovascular effects of the drugs.