Type II Diabetes is reaching epidemic proportions in this country. There are many theories on the reason for this phenomenon, but few will disagree that rising levels of obesity play a role. Many people do not realize, however, that when it comes to men with Diabetes, there are hormonal issues at play. One of every three men with Type II Diabetes has low Testosterone. In fact, men with Diabetes are much more likely to have low Testosterone than men without Diabetes.
As men age beyond 40 years, they experience a decline in serum Testosterone - usually about 1-2% per year. This fall may impact physical, sexual, and/or psychological aspects of men's health. A major role of Testosterone is regulation of fat mass and lean muscle mass. As Testosterone levels decline, so does lean muscle mass, and fat mass rises. Studies have shown that between the ages of 25-65, the average man will lose over 25lbs of lean muscle, and gain at least 25lbs of fat. This extra fat mass is often deposited in the abdomen - in and around the abdominal organs. This visceral fat has important implications in terms of metabolic health.
This visceral fat is not only storing fat, but is also releasing hormones and other chemical messengers that lead to a condition called insulin resistance. This insulin resistance (IR) is defined as an impaired biologic response to insulin - it is a disorder of insufficient insulin efficacy. Obesity is the most common cause of IR, and IR is a common precursor to Diabetes. So it is easy to see that any therapy that helps reduce this visceral, abdominal fat will likely have a positive effect on IR and help reduce the chance of getting Diabetes.
It is clear from many studies that Testosterone therapy in hypogonadal men leads to positive outcomes in body composition - loss of fat mass and increase in lean muscle. Some studies have even gone on to show a decrease in insulin resistance associated with Testosterone therapy. It is unclear as to whether this improvement in IR is due entirely to changes in body composition, or perhaps Testosterone itself could play a role in insulin sensitivity. More studies are needed.
This whole relationship between Diabetes, Testosterone, and Obesity is complex. For instance, not everyone with low Testosterone becomes obese, and not all obese people develop diabetes. But with the high prevalence of low Testosterone in Diabetic men, many physicians feel that all men with diabetes should be screened for low Testosterone. If low Testosterone is found, the patient and his physician can make an informed decision regarding Testosterone therapy.
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