Clinical and Biochemical Assessment of Hypogonadism in Men With Type 2 Diabetes

Kapoor, Dheeraj; Aldred, Hazel; Clark, S. Michael; Channer, Kevin S.; Jones, T. Hugh

doi:10.2337/dc06-1426

Cited by 458 publications

(446 citation statements)

References 49 publications

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“…The Endocrine Society in the USA recommends the routine measurement of serum testosterone levels in patients with type 2 diabetes because of the high prevalence. 6,14 Certainly, from our data and the high prevalence in our patient population, the routine screening of all type 2 diabetic men aged 50 years and older in a setting similar to ours would appear to be advisable at first glance.…”

Section: Discussionmentioning

confidence: 99%

“…Type 2 diabetic men with low testosterone levels have been found to have a high prevalence of symptoms of hypogonadism, such as erectile dysfunction, low libido and fatigability. 14,18 …”

Section: Introductionmentioning

confidence: 99%

“…Thus, it is possible that this precedes diabetes. 11,14 Obesity is a proinflammatory state. 3 Visceral fat produces inflammatory cytokines, adipokines and other proinflammatory factors, such as interleukin (IL)-6, IL-1β, tumour necrosis factor-alpha, plasminogen activator inhibitor-1, angiotensinogen, vascular endothelial growth factor and serum amyloid A. Obesity also leads to an increased release of oestrogen and free fatty acid.…”

Section: Introductionmentioning

confidence: 99%

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The prevalence and association of low testosterone levels in a South African male, diabetic, urban population

Kemp

Rheeder

2015

Journal of Endocrinology, Metabolism and Diabetes of South Afri

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Background: According to the literature, low serum testosterone levels are associated with diabetes mellitus. No or minimal data exist for its prevalence or predictors in South Africa. Design: This was a cross-sectional study. Setting: The setting was an academic centre, i.e. the University of Pretoria and Steve Biko Academic Hospital Diabetes Clinic. Subjects: A total of 150 consecutive male patients aged 50 years and older with diabetes mellitus were selected using convenience sampling. Outcome measures: The patients were evaluated for diabetes control and complications, and for hypogonadism symptoms. Early-morning serum testosterone levels were determined. Results: The prevalence of androgen deficiency symptoms was 94.7%. Some 50% of the men had low total testosterone levels. Using multivariate logistic regression, the significant factors associated with low total testosterone were waist circumference and known cardiovascular disease. The prevalence of symptoms of androgen deficiency was very high; 94.7% of the patients reported a significant number of symptoms listed on the Androgen Deficiency in the Aging Male questionnaire. Conclusion: This study confirms the high prevalence of low testosterone levels in diabetic male patients in a tertiary setting. Universal screening remains controversial owing to uncertainty regarding the risks and benefits of testosterone therapy in this population group. Predictors of low testosterone levels were identified.

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Section: Discussionmentioning

confidence: 99%

“…Type 2 diabetic men with low testosterone levels have been found to have a high prevalence of symptoms of hypogonadism, such as erectile dysfunction, low libido and fatigability. 14,18 …”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The prevalence and association of low testosterone levels in a South African male, diabetic, urban population

Kemp

Rheeder

2015

Journal of Endocrinology, Metabolism and Diabetes of South Afri

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“…Consistent with this notion, androgen deficiency has been associated with insulin resistance, type 2 diabetes mellitus, metabolic syndrome, and increased deposition of visceral fat. [62][63][64][65] In the TIMES2 (Testosterone Replacement In Hypogonadal Men With Either Metabolic Syndrome or Type 2 Diabetes) study, 6 to 12 months of transdermal TRT (vs placebo) significantly improved insulin resistance and glycemic control in a large randomized study of hypogonadal men with type 2 diabetes mellitus (ACCF/AHA class Ib). 66 A meta-analysis of 5 other randomized controlled trials (including 3 placebo-controlled trials) with mean follow-up of 58 weeks found that TRT was associated with a significant reduction in fasting plasma glucose levels, homeostasis model assessment of insulin resistance index, triglycerides, and WC.…”

Section: Recommended Assessments and Risk Clarificationmentioning

confidence: 99%

The Princeton III Consensus Recommendations for the Management of Erectile Dysfunction and Cardiovascular Disease

Nehra

Jackson

Miner

et al. 2012

Mayo Clinic Proceedings

420

341

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The Princeton Consensus (Expert Panel) Conference is a multispecialty collaborative tradition dedicated to optimizing sexual function and preserving cardiovascular health. The third Princeton Consensus met November 8 to 10, 2010, and had 2 primary objectives. The first objective focused on the evaluation and management of cardiovascular risk in men with erectile dysfunction (ED) and no known cardiovascular disease (CVD), with particular emphasis on identification of men with ED who may require additional cardiologic work-up. The second objective focused on reevaluation and modification of previous recommendations for evaluation of cardiac risk associated with sexual activity in men with known CVD. The Panel's recommendations build on those developed during the first and second Princeton Consensus Conferences, first emphasizing the use of exercise ability and stress testing to ensure that each man's cardiovascular health is consistent with the physical demands of sexual activity before prescribing treatment for ED, and second highlighting the link between ED and CVD, which may be asymptomatic and may benefit from cardiovascular risk reduction. T he Princeton Consensus Conference is a multispecialty collaborative tradition dedicated to optimizing sexual function and preserving cardiovascular health. The first conference convened in June 1999 to develop recommendations for clinical management of sexual dysfunction in men and women with known cardiovascular disease (CVD). This conference also provided a multidisciplinary forum for evaluation of the potential cardiovascular risk posed by sexual activity in atrisk patients. The first Princeton Consensus Conference recommendations 1 included stratification of patients by level of cardiac risk associated with sexual activity based on existing CVD. Those at low risk could initiate or resume sexual activity and be treated for sexual dysfunction. For those at high risk, sexual activity was deferred until the cardiac condition was stabilized. The second Princeton Consensus Conference convened in June 2004 and expanded the recommendations of the first conference to emphasize risk factor evaluation and lifestyle management for all men with erectile dysfunction (ED). 2 The second conference recommendations also incorporated new information on the appropriate use of phosphodiesterase type 5 (PDE5) inhibitors in men with ED and concomitant CVD.The third Princeton Consensus Conference took place November 8 to 10, 2010, in Miami Beach, Florida. The group revisited and updated their 2005 recommendations regarding the cardiovascular risk associated with sexual activity in men with known CVD. 2 In addition, the third conference focused on the predictive value of vasculogenic ED in assigning cardiovascular risk in men of all ages, with the primary objective being development of an approach to cardiovascular risk assessment in younger men with ED and no known CVD. The role of testosterone in erectile function and cardiovascular health and the utility of testosterone replacement...

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“…Testosterone is lower in men with the metabolic syndrome or with type 2 diabetes, in comparison to metabolically healthy men (1,2). Dysfunction of the gonadal axis is central (hypogonadotrophic hypogonadism) as gonadotropins are within the normal range.…”

Section: Introductionmentioning

confidence: 97%

Liver iron overload is associated with elevated SHBG concentration and moderate hypogonadotrophic hypogonadism in dysmetabolic men without genetic haemochromatosis

Gautier

Lainé

Massart

et al. 2011

European Journal of Endocrinology

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Aims: To assess the relation between moderate iron overload on sex hormone binding globulin (SHBG) levels and gonadotroph function in men with dysmetabolic iron overload syndrome and the effects of phlebotomy. Methods: The relationship between magnetic resonance imaging assessed liver iron concentration (LIC) and plasma ferritin levels with total testosterone, bioavailable testosterone (BT), SHBG and LH levels, were studied in 50 men with moderate dysmetabolic iron excess, in the absence of genetic haemochromatosis, who were randomised to phlebotomy therapy or to normal care. Results: Four patients (8%) had low total testosterone (!10.4 nmol/l) and 13 patients (26%) had low BT (!2.5 nmol/l). In the entire population, those with LIC above the median (90 mmol/l) had a higher mean SHBG (PZ0.028), lower LH (PZ0.039) than those with LIC below the median. In multivariable analysis (adjusted for age, and fasting insulin) LIC was significantly associated with SHBG (positively) and LH (negatively). Patients in the highest quartile of SHBG had higher LIC (PZ0.010) and higher ferritinaemia (PZ0.012) than those in the three other quartiles. Iron depletion by venesection did not significantly improve any hormonal levels. Conclusions: Hypogonadism is not infrequent in men with dysmetabolic iron overload syndrome. Liver iron excess is associated with increased plasma SHBG and moderate hypogonadotrophic hypogonadism. Phlebotomy therapy needs further investigation in symptomatic hypogonadal men with dysmetabolic iron excess.

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Clinical and Biochemical Assessment of Hypogonadism in Men With Type 2 Diabetes

Cited by 458 publications

References 49 publications

The prevalence and association of low testosterone levels in a South African male, diabetic, urban population

The prevalence and association of low testosterone levels in a South African male, diabetic, urban population

The Princeton III Consensus Recommendations for the Management of Erectile Dysfunction and Cardiovascular Disease

Liver iron overload is associated with elevated SHBG concentration and moderate hypogonadotrophic hypogonadism in dysmetabolic men without genetic haemochromatosis

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