Diabetes Complications

Can Low Testosterone Increase the Risk of Type 2 Diabetes?

With its prevalence on the rise, it’s no wonder people are interested in learning about the potential risk factors for developing type 2 diabetes.

Learning about these risk factors can help people make decisions in an effort to minimize their risk and preserve their health.

One of these risk factors may be low testosterone; a hormone presents predominantly in men.

What is the role of testosterone?

Testosterone is a primary male sex hormone and is also called an androgen. It is primarily produced in the testicles and serves many functions in males, such as:

  • The development of the penis and testes

  • The deepening of the voice during puberty

  • The appearance of facial and pubic hair starting at puberty; later in life, it may play a role in balding

  • Muscle size and strength

  • Bone growth and strength

  • Sex drive (libido)

  • Erectile dysfunction

  • Sperm production

While testosterone is the primary sex hormone in men, it’s also present in females as well. Testosterone is produced in the ovaries, as well as the adrenal glands The role of testosterone in females includes:

  • Ovarian function

  • Bone strength

  • Sexual behavior, including normal libido (though the evidence is not conclusive)

Symptoms of low testosterone

Having low testosterone can result in several negative symptoms, such as:

  • Reduced body and facial hair

  • Loss of muscle mass

  • Low libido, impotence, small testicles, reduced sperm count and infertility

  • Increased breast size

  • Hot flashes

  • Irritability, poor concentration, and depression

  • Loss of body hair

  • Brittle bones and an increased risk of fracture

Having high testosterone is also associated with several symptoms in men, including:

  • Low sperm counts, shrinking of the testicles and impotence

  • Heart muscle damage and increased risk of heart attack

  • Prostate enlargement with difficulty urinating

  • Liver disease

  • Acne

  • Fluid retention with swelling of the legs and feet

  • Weight gain

  • High blood pressure and cholesterol

  • Insomnia

  • Headaches

  • Increased muscle mass

  • Increased risk of blood clots

  • Stunted growth in adolescents

  • Uncharacteristically aggressive behavior (although not well studied or clearly proven)

  • Mood swings, euphoria, irritability, impaired judgment, delusions

High testosterone in women often occurs in those with polycystic ovarian syndrome (PCOS), though there are other causes as well. Common symptoms of high testosterone in women include increased facial hair growth and acne.

How is testosterone linked with diabetes?

Research is a bit controversial when it comes to testosterone and its role in causing diabetes. Some studies have found an increased risk of developing type 2 diabetes with low testosterone.

Other studies conclude that having low testosterone isn’t a risk factor for developing diabetes. Men with type 2 diabetes tend to have lower levels of testosterone than men without diabetes, but this doesn’t necessarily prove that low testosterone alone caused their diabetes.

A meta-analysis published in 2018 concluded that “higher testosterone level can significantly decrease the risk of [type 2 diabetes] in men, and testosterone is an important protective factor against [type 2 diabetes] in men.”

The researchers also noted that more research needs to be done on the efficacy of testosterone supplementation in reducing diabetes risk and improving outcomes in those with low testosterone and existing diabetes.

Testosterone is directly related to insulin sensitivity and lipid (blood fat/cholesterol) metabolism.

Other studies have found a link between low testosterone and metabolic syndrome, which increases the risk of diabetes. Low testosterone increases fat storage and decreases muscle mass in men, which can contribute to obesity, which is a symptom of metabolic syndrome.

Low testosterone in men with diabetes

As mentioned earlier, men with type 2 diabetes tend to have lower levels of testosterone than those without diabetes; in fact, around 1 in 6 diabetic men also have low testosterone. Other potential causes of low testosterone, or hypogonadism, include:

  • Injury or infection to the testes

  • Chemotherapy

  • Certain medications

  • Obesity/increased fat

  • Alcohol abuse

  • Liver cirrhosis

  • Chronic kidney failure

  • Prior anabolic steroid use

  • Head injury

  • Severe hypothyroidism

  • Certain genetic conditions

  • Hypogonadotropic hypogonadism

In addition to the link between low testosterone and type 2 diabetes, there is also a link between low testosterone and cardiovascular disease (heart disease).

Reduced levels of testosterone may increase the risk of death from heart disease by as much as 25%. People with diabetes are already at greater risk of developing heart disease, so managing testosterone levels in those with type 2 diabetes is important for heart health.

Low testosterone in women with diabetes

Women with high testosterone tend to have higher levels of visceral fat and also may have an increased risk of type 2 diabetes.

However, low testosterone in women doesn’t seem to have the same adverse effects as it does on men regarding blood sugar and diabetes risk. Low testosterone does cause side effects such as reduced libido, depressed mood, lethargy, and muscle weakness in women.

A common cause of high testosterone in women is polycystic ovarian syndrome (PCOS). PCOS is a syndrome resulting from a hormonal imbalance. Part of this hormonal imbalance includes increased androgens, such as testosterone.

Women with PCOS often have insulin resistance, which is a risk factor for developing type 2 diabetes. Therefore, it’s increased testosterone levels, which may be associated with type 2 diabetes in women.

Managing diabetes and low testosterone

For men with low testosterone and diabetes, there are treatment options available. Conventional treatments for low testosterone include:

  • Skin patch – applied once every 24 hours, patches release small amounts of testosterone into the skin.

  • Gels – Topical gels are spread daily onto the skin over both upper arms, shoulders, or thighs.

  • Oral therapy – Capsules are swallowed, or tablets are attached to your gums or inner cheek twice a day.

  • Pellets – These are implanted under the skin, usually around the hips or buttocks, and slowly release testosterone. They are replaced every three to six months.

  • Injections – Various formulations are injected every seven to 14 days.

  • DHEA supplements -A treatment option for low testosterone in women.

Certain people shouldn’t receive treatment for low testosterone, such as those who have:

  • prostate cancer or breast cancer

  • an elevated blood level of prostate-specific antigen (a blood test used to screen for prostate cancer)

  • a prostate nodule that can be felt during a rectal exam

  • plan to become a father soon

  • an elevated red blood cell count

  • severe, untreated sleep apnea

  • severe lower urinary tract symptoms

  • poorly controlled heart failure

  • have had a heart attack or stroke within the last 6 months

  • tend to form blood clots (thrombophilia)

Treating low testosterone in those with type 2 diabetes may help improve glycemic control. However, some studies have found that testosterone therapy may not improve glucose metabolism (blood sugar) or visceral adiposity (body fat) in men with type 2 diabetes.

It’s essential to discuss with your healthcare provider if you’re considering treatment for low testosterone, as individual responses tend to vary.

How can you balance your testosterone levels?

There are ways to promote healthy testosterone levels naturally.

  • Regular exercise: Studies find that men who are more physically active tend to experience an increase in testosterone levels. This includes not only aerobic exercise but weight lifting as well.

    In women with high testosterone due to PCOS, physical activity can help improve insulin resistance and improve blood sugars and may reduce androgen levels as well.

  • Healthy diet: Eating a balanced, healthy diet may promote a healthy weight and more normal testosterone levels. Some studies find that the typical Western diet (processed and fried foods) may cause a reduction in testosterone levels.

    Healthy eating is an important part of managing PCOS. Eating a diet low in saturated fat, refined carbs, and sugar may help improve PCOS symptoms, including increased testosterone.

  • Manage stress levels: Increased cortisol levels can interfere with testosterone production. Cortisol is a hormone released from areas of the brain in response to stress and fear.

  • Ensure adequate vitamin D consumption: Supplementing with vitamin D may help increase testosterone levels in men. The recommended amount of vitamin D for most adults is between 600-800 IU per day, but amounts up to 1,500-2,000 IU daily is likely also safe.

Conclusion

Men with diabetes tend to have low levels of testosterone. Some studies have found that low testosterone can be a risk factor for developing type 2 diabetes, but this isn’t a conclusive result, among other research done on the topic. It’s really a “which came first, the chicken or the egg” type of debate!

Low testosterone can cause many adverse side effects. Low testosterone is also associated with an increased risk of cardiovascular disease.

People with diabetes are already at an increased risk of developing heart disease. Because of these risks and side effects, some men opt to treat their low testosterone medically, such as through hormone therapy.

Women can have elevated levels of high testosterone in the case of disorders such as polycystic ovarian syndrome (PCOS). PCOS is associated with insulin resistance and an increased risk of developing type 2 diabetes. Low testosterone in women isn’t associated with the same dangers pertaining to diabetes as it is for men.

People can promote healthy testosterone levels naturally. Being physically active, eating a healthy diet, managing stress, and ensuring adequate vitamin D intake are all associated with promoting more desirable testosterone levels.

Sources

  1. Hackett G. Type 2 Diabetes and Testosterone Therapy. World J Mens Health. 2019;37(1):31–44. doi:10.5534/wjmh.180027
  2. https://www.diabetes.org.uk/about_us/news_landing_page/type-2-diabetes-risk-linked-to-low-testosterone-levels
  3. Mathis Grossmann, Low Testosterone in Men with Type 2 Diabetes: Significance and Treatment, The Journal of Clinical Endocrinology & Metabolism, Volume 96, Issue 8, 1 August 2011, Pages 2341–2353, https://doi.org/10.1210/jc.2011-0118
  4. Yao QM, Wang B, An XF, Zhang JA, Ding L. Testosterone level and risk of type 2 diabetes in men: a systematic review and meta-analysis. Endocr Connect. 2018;7(1):220–231. doi:10.1530/EC-17-0253
  5. Beatrice AM, Dutta D, Kumar M, et al. Testosterone levels and type 2 diabetes in men: current knowledge and clinical implications. Diabetes Metab Syndr Obes. 2014;7:481–486. Published 2014 Oct 20. doi:10.2147/DMSO.S50777

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