Weight loss more than glycemic control may improve testosterone in obese type 2 diabetes mellitus men with hypogonadism

Abstract

Background: Functional hypogonadism is a common disorder among patients with obesity and type 2 diabetes mellitus and could be managed by first treating the underlying causes.Objective: The present study was undertaken to investigate the contribution of body weight and glycemic control to the reversibility of hypogonadism to eugonadism in a real-life setting. Materials and methods:Adult obese male patients with uncontrolled type 2 diabetes mellitus, complaining of mild to moderate erectile dysfunction and suspected of functional hypogonadism evaluated at our institution from 2015 to 2017, were retrospectively included. The gonadal status 3 and 12 months after the glucose-lowering medication prescription was assessed.Results: Seventy-one consecutive patients were enrolled, with 24 (34%) of them achieving total testosterone ≥300 ng/dL (10.4 nM/L) at the end of the study. When they were stratified according to HbA1c and body weight loss, a direct correlation was found for the latter only. Particularly, 94% of patients achieving a body weight loss >10% presented with total testosterone ≥300 ng/dL. An inverse correlation was found for HbA1c, with no higher prevalence of total testosterone ≥300 ng/dL in patients with HbA1c <6.5%. Discussion:The findings are strengthened by the rigorous study design. However, a limited number of patients and glucose-lowering medications could be included. Conclusions:The present study supports the hypothesis that in obese patients with uncontrolled type 2 diabetes mellitus losing weight may have a greater impact on androgens compared to improving glycemic control. Further prospective studies are needed to corroborate this finding. K E Y W O R D Sfunctional hypogonadism, erectile dysfunction, type 2 diabetes mellitus, obesity | 655 GIAGULLI et AL.

The ketogenic diet corrects metabolic hypogonadism and preserves pancreatic ß-cell function in overweight/obese men: a single-arm uncontrolled study

“…In the present study, we report the effects of VLCKD on TT levels. Metabolic hypogonadism is a functional and potentially reversible condition, which can benefit from diet, bariatric surgery, and even drugs such as selective estrogen receptor modulators (SERM) [ 8 , 52 – 54 ]. At the best of our knowledge, this is the first study showing the effects of VLCKD on metabolic hypogonadism.…”

Critical evaluation of different available guidelines for late‐onset hypogonadism

“…Recently, preliminary results on the disorder to be preferentially targeted have been published. In obese patients with uncontrolled type 2 diabetes and hypogonadism were prescribed with lifestyle measures and metformin with or without glucagon‐like peptide 1 receptor agonists or sodium‐glucose cotransporter 2 inhibitors, losing more than 10% of the initial body weight was associated with a significant improvement in TT and FT and chances of achieving TT of at least 10.4 nmol/L (300 ng/dL) irrespective of changes in glycaemic control 91 . Therefore, current recommendations placing a high value on the management of obesity should be considered as reliable and up‐to‐date, even when the use of newly introduced pharmacologic therapies for the management of type 2 diabetes is considered.…”

Organic Diet and Intermittent Fasting are Associated With Improved Erectile Function

“…Intermittent fasting, for instance, has been reported to improve glycemic control, increase efficient nutrient metabolism, and boost testosterone levels. [17][18][19] In contrast, organic diets limit exposure to pesticide and fertilizers − both of which are known contributors to adverse developmental and neurological disorders. [20][21][22] Even further, organic foods are reported to have higher nutritional value than conventional food wherein higher concentrations of vitamins and antioxidants can reduce oxidative stress and inflammatory processes.…”