Low Testosterone as a Risk Factor for Prediabetes
Yes, low testosterone is a significant risk factor for prediabetes, with evidence showing that men with prediabetes have an increased risk of testosterone deficiency independent of obesity and metabolic syndrome. 1
Relationship Between Low Testosterone and Prediabetes
Epidemiological Evidence
- Men with prediabetes have an increased risk of testosterone deficiency compared to normoglycemic individuals (age-adjusted OR=1.87; 95% CI=1.38-2.54) 1
- This risk remains significant even after adjusting for metabolic syndrome, with the risk in prediabetic men equaling that of diabetic patients 1
- All prediabetes markers (impaired fasting glucose, impaired postprandial glucose, and HbA1c 5.7%-6.4%) are associated with increased risk of testosterone deficiency 1
Bidirectional Relationship
- Low testosterone predicts future risk of type 2 diabetes in men with prediabetes 2
- Obesity is a major confounder in this relationship, as it is associated with both lower testosterone levels and increased risk of prediabetes 3, 4
- Mean testosterone levels are lower in men with diabetes compared to age-matched men without diabetes 3
Clinical Implications
Screening Recommendations
- Morning total testosterone level (drawn between 8-10 AM) is the initial test for suspected hypogonadism, with repeat measurement on a different day for confirmation 4
- Free testosterone should be measured by equilibrium dialysis or calculated using accurate formulas that include total testosterone, SHBG, and albumin 4
- Consider routine testosterone measurement in men with prediabetes 1
Prevention Potential
- Testosterone treatment has shown promise in preventing progression from prediabetes to type 2 diabetes:
- In a randomized controlled trial of 1,007 men with impaired glucose tolerance or newly diagnosed type 2 diabetes, testosterone treatment reduced the risk of type 2 diabetes by 40% when combined with lifestyle intervention 5, 6
- In an 8-year registry study, 90% of hypogonadal men with prediabetes who received testosterone therapy achieved normal glucose regulation (HbA1c <5.7%), while 40.2% of untreated men progressed to type 2 diabetes 7
Treatment Considerations
- Testosterone replacement in men with symptomatic hypogonadism may provide benefits including improved sexual function, well-being, muscle mass and strength, and bone density 3
- Treatment also reduces fat mass and insulin resistance, which are beneficial for metabolic health 5
- However, testosterone replacement in older men has been associated with increased coronary artery plaque volume 3, 4
Cautions and Monitoring
Before initiating testosterone therapy, comprehensive evaluation is necessary including:
Contraindications to testosterone replacement include breast or prostate cancer, elevated PSA, severe untreated sleep apnea, severe lower urinary tract symptoms, recent myocardial infarction or stroke, uncontrolled heart failure, and thrombophilia 4
Long-term safety and cardiovascular effects of testosterone treatment for prediabetes prevention require further investigation 2, 6
While the evidence supports low testosterone as a risk factor for prediabetes, more studies are needed before testosterone treatment can be broadly recommended specifically for prediabetes prevention in men without established hypogonadism 2.