Testosterone Replacement Therapy and the Risk of Hypoglycemia

Abstract

We report the case of a 45-year-old man with a history of Klinefelter syndrome undergoing testosterone replacement therapy, and with type 2 diabetes treated with metformin with poor metabolic control. When vildagliptin was added to his treatment, he presented hypoglycemia after the testosterone injection. We highlight this not widely reported drug interaction between hypoglycemic agents and testosterone.

Metabolic and Nutritional Aspects in Paediatric Patients with Klinefelter Syndrome: A Narrative Review

“…The median survival rate is 2 to 5 years lower compared to peers. The augmented mortality rate is connected especially to cardiovascular diseases and endocrine metabolism disorders [ 3 , 12 ]. In fact, KS could have effects on body composition, insulin sensitivity, bone metabolism and cardiovascular morbidity, with an increased risk of diabetes, metabolic syndrome, osteoporosis and cardiac disease [ 7 , 13 ].…”

“…Moreover, there is a vicious circle between abdominal adiposity and insulin resistance, with abdominal adiposity causing insulin impairment [ 7 , 15 ]. In addition, insulin resistance usually worsens hypogonadism by lowering hypothalamic activity and impairing Leydig cell function [ 12 ].…”

“…Despite the clear connection between hypogonadism and metabolic alterations, in patients affected by KS, this interaction is extremely complex because hypogonadism is not the only factor that should be considered [ 4 ]. In fact, metabolic abnormalities partially subsist due to the genetic disease itself [ 12 ].…”

“…Moreover, an improvement in sexual function and an increase in libido have been described. Testosterone therapy appears to play a positive role in abdominal adiposity and weight loss, insulin sensitivity, insulin secretion and glucose uptake by muscle cells [ 3 , 12 ]. Finally, TRT also has a positive effect on bone mass density, in particular at the lumbar level [ 49 ].…”

Glucose Metabolic Disorder in Klinefelter Syndrome: A Retrospective Analysis in a Single Chinese Hospital and Literature Review

“…We searched PubMed for manuscripts with full text in English published prior to February 2020 using key words "Klinefelter syndrome" AND "diabetes mellitus" OR "insulin resistance" OR "hyperglycemia" OR "impaired glucose tolerance" OR "impaired fasting glucose" OR "metabolic syndrome". Two co-authors extracted the medical information of the enrolled patients and the literatures using standardized forms, there were 12 studies [9,11,[20][21][22][23][24][25][26][27][28][29]and 10 case reports [30][31][32][33][34][35][36][37][38][39] of Klinefelter syndrome combined with DM or prediabetes selected.…”