Current research speaks to the connection between testosterone deficiency and the risk of insulin resistance development – so much so that reversing nature’s decline in testosterone production can put the brakes on diabetes development. In this article on testosterone therapy and diabetes, we look at what diabetes is, and how testosterone plays a role in insulin resistance and elevated blood glucose levels.
As many as 30 million people (1 in 7 Americans) may have diabetes and not know it. 14% of US adults have diabetes, yet 4% of them are unaware of their medical state. The older a person gets, the higher the risk of developing type 2 diabetes. What is worse is that being unaware of this condition increases the risk of future health issues, such as strokes and heart attacks.
In a groundbreaking new report that came out in the spring of 2019 on testosterone replacement therapy and diabetes, researchers found that TRT could actually halt prediabetes progression. In the findings published in the March 8, 2019 issue of Diabetes Care, the researchers studied 229 men treated with testosterone and compared their results to 87 who only received a placebo. An astounding 90% of the men undergoing testosterone therapy achieved normal glucose regulation. Before the study, all the participants had low testosterone levels and symptoms as well as prediabetes. Of those who did not receive TRT, 40.2% progressed from prediabetes to type 2 diabetes.
The clinical trial lasted 8 years, highlighting the benefit of long-term testosterone therapy for men. Testosterone levels in the treated group increased to between 461 and 510 ng/dL while those in the control group stayed at 260 to 317 ng/dL.
Other important results after the 8 years included:
- Testosterone treated men lost an average of 8.8 kg (19.40 pounds) of body fat while those in the control group gained an average of 9.1 kg (20.06 pounds)
- Total cholesterol levels decreased by 1.3 mmol/L in those receiving TRT and increased 0.8 mmol/L in those who did not receive testosterone therapy
- LDL cholesterol levels decreased by 0.9 mmol/L after TRT and increased 0.5 mmol/L in men not receiving treatment
- A reduction in triglyceride levels of 0.5 mmol/L occurred in treated men, and an increase of 0.5 mmol/L was seen in untreated men
- Mortality rates during that time were 7.4% in TRT-treated men and 16.1% in untreated men.
These outcomes show how important it is for men with symptoms of hypogonadism or prediabetes to undergo blood analysis for these conditions. Early treatment for testosterone deficiency can help reduce the risk of prediabetes progressing to diabetes.
Emerging research shows that testosterone therapy can reduce the risk of prediabetes developing into diabetes in men.
What Is Diabetes?
Before we discuss testosterone therapy and diabetes, it might help to understand better what diabetes is and why it happens. Diabetes is a medical condition that stems from the bloodstream having too much glucose (sugar). There are different reasons why glucose remains in the bloodstream, which can influence whether a person has type 1 or type 2 diabetes. We will discuss the differences between those two forms of diabetes in the next section.
When a person eats, the consumed food undergoes processing by a complex series of steps involving the mouth, esophagus, stomach, small intestine, pancreas, liver, large intestine, and numerous digestive enzymes. A process called peristalsis pushes the food and liquid consumed along the GI tract. Digested nutrients absorb through the walls of the small intestines into the bloodstream. The body uses these nutrients for energy.
The pancreas is extremely important in this cycle as it not only helps with digestive enzymes, but it also secretes the insulin that tells the body’s cells to take in the circulating glucose. If there is not enough insulin, or if the cells become resistant to insulin’s effects, the glucose will remain in the bloodstream. If blood sugar levels continue to remain elevated, a person will develop diabetes.
One connection between diabetes and testosterone therapy is that testosterone is a hormone that increases tissue and cell sensitivity to insulin. That allows for more glucose uptake by the cells. A person who has low testosterone levels may find that their blood glucose levels rise.
Weight is a serious issue for many adults in the US. Obesity is on the rise, and weight gain is synonymous with both testosterone deficiency and diabetes. Statistics tell a frightening story:
- Obesity in men increases the risk of a low testosterone diagnosis by 2.4 times
- Men with diabetes have a 2.1 times greater incidence of low testosterone
- High blood pressure in males increase the risk of low testosterone 1.8 times
Weight gain, elevated blood pressure, high cholesterol and triglycerides, insulin resistance, metabolic syndrome, and low testosterone are all connected.
Diabetes occurs when the blood contains too much glucose, which can occur when low testosterone impedes cellular sensitivity to insulin.
Different Types of Diabetes
As we continue our discussion of testosterone therapy and diabetes, we look at the three distinct types of diabetes:
- Type 1 diabetesThe most common form of childhood-onset diabetes, type 1 occurs when the pancreas does not produce enough insulin. Instead, the immune system attacks the cells in the pancreas that produce insulin, destroying them, and preventing the body’s cells from receiving the signals they need to take in blood glucose. Adults can also get type 1 diabetes, even though it is most often diagnosed at a young age.
- Types 2 diabetesIn type 2 diabetes, the pancreas either produces too little insulin, or the cells become resistant to insulin effects. When that occurs, the pancreas continues to sense glucose in the bloodstream, secreting more and more insulin until a person has both elevated insulin and blood sugar levels. Although most common in older adults, children can be diagnosed with type 2 diabetes.
- Gestational diabetesA form of diabetes that occurs during pregnancy, gestational diabetes typically disappears after birth. However, gestational diabetes does increase the risk of type 2 diabetes development in later life.
Family history, obesity, physical inactivity, high blood pressure, race, and age (over 45) increase the risk of developing type 2 diabetes. That is why looking at testosterone levels is crucial if you fall into this group and have symptoms of Low T. Continue reading to learn more about testosterone therapy and diabetes.
In all cases, diabetes causes too much glucose to remain in the bloodstream.
Testosterone and Diabetes Type 1
An association exists between free testosterone levels and abdominal obesity, insulin resistance, and glucose levels in men with type 1 diabetes. Obesity is a critical factor in this relationship, further reducing testosterone levels as belly fat leads to an increase in aromatase production, which converts testosterone into estrogen. When we look at type 1 diabetes and testosterone therapy, we find that TRT helps to improve insulin metabolism, making it a beneficial treatment for insulin resistance.
In one study of testosterone therapy and diabetes type 1, it was found that subcutaneous insulin treatment could increase the risk of hypogonadism. The men in the study who had type 1 diabetes exhibited similar testosterone levels to the control group, but they had higher sex hormone-binding globulin (SHBG), lower free testosterone, and higher follicle-stimulating hormone (FSH) and estrone levels. Luteinizing hormone (LH) and estradiol were similar, but DHEA, androstenedione, and androstenedione rations to progesterone and 17-hydroxyprogesterone were higher, as were CBG and cortisol levels. Since cortisol is antagonistic towards testosterone, it is not surprising that its levels were higher when free testosterone was lower.
According to research, as many as 10% of men with type 1 diabetes may suffer from hypogonadism. The study showed that TRT might provide benefits for lipid profiles, glycemic control, and erectile function.
Testosterone therapy may have benefits for obese men with type 1 diabetes, hypogonadism, and abdominal obesity.
Testosterone and Diabetes Type 2
As many as one-third of all men with type 2 diabetes may have hypogonadism. Together, these conditions increase the risk of cardiovascular as well as all-cause mortality. Low testosterone increases the risk of weight gain, metabolic syndrome, and type 2 diabetes. There has never been a more important time than right now to discuss the benefits of testosterone replacement therapy and type 2 diabetes improvements.
In one of the largest studies of men with type 2 diabetes and low testosterone, TRT resulted in the following:
- Weight reduction, improved BMI, and decrease in waist circumference
- Better sexual function
- Higher quality of life scores
Weight loss is one of the top methods of improving the symptoms of type 2 diabetes.
Other studies have backed up these results, along with improved insulin resistance and glycemic control. Research has also shown a decrease in all-cause mortality for men with cardiometabolic diseases. Improved bone density, red blood cell production, and increased lean muscle mass are other positive benefits, as are better mood and reduced feelings of depression.
For men who receive testosterone therapy and type 2 diabetes monitoring, the many benefits of treatment may also lead to diabetes remission, as we will discuss below.
Type 2 diabetes and low testosterone increase the risk of all-cause and cardiovascular mortality. Testosterone therapy can decrease these risks.
Testosterone Deficiency, Blood Sugar, and Insulin
The use of testosterone therapy for diabetes has many benefits. The first of which is to help increase the cells’ sensitivity to insulin. By doing so, the body’s tissues receive more glucose, reducing blood sugar levels. Glucose is the fuel that provides energy to the body’s cells. If too much glucose remains in the bloodstream, it winds up in the liver, turning into stored glycogen. Too much glycogen can result in fatty liver disease.
Another reason why we look closely at testosterone therapy and diabetes is that when the cells are resistant to the effects of insulin, the pancreas secretes more insulin into the bloodstream to try and force glucose into the cells. With the blood saturated with both insulin and glucose, significant health issues can arise. After a while, the pancreas becomes overworked and can no longer secrete insulin.
By increasing low testosterone levels, the cells become sensitive to the circulating insulin, allowing them to take in the glucose and lowering blood sugar levels. For people with type 2 diabetes who are using insulin, that often means a decrease in insulin need. Of course, close monitoring by the doctor is required to ensure healthy blood sugar and testosterone levels.
The use of testosterone therapy can improve cellular sensitivity to insulin to reduce blood glucose levels.
Can Testosterone Improve Diabetes Symptoms?
A 2018 study of men with type 2 diabetes and hypogonadism brought some startling results – long-term TRT may lead to diabetes remission. The men in the study were followed for an average of 6.9 years, some as many as 11 years. At the end of the study, 12% of the men experience remission of their diabetes. Another important outcome of this research is that the control group of men that did not receive testosterone therapy had a threefold increase in mortality, often due to cardiovascular nature. The study’s findings reiterate what we know to be true – testosterone therapy does not increase the risk of cardiovascular events – it decreases it for men who have low testosterone levels.
In one study of testosterone therapy and diabetes, TRT increased glucose uptake by the tissues 32%, significantly lowering fasting glucose levels.
To learn more about how testosterone therapy can improve the symptoms of diabetes, and if you are a candidate for hormone replacement treatment, contact RX Hormone medical center for a confidential consultation at no charge.