From the Guidelines
Yes, there is a relationship between type 1 diabetes and low testosterone, as men with type 1 diabetes have a higher prevalence of hypogonadism compared to men without diabetes. This connection occurs because chronic hyperglycemia can damage the hypothalamic-pituitary-gonadal axis, which regulates testosterone production, as noted in the most recent guidelines 1. Additionally, insulin resistance, inflammation, and oxidative stress associated with diabetes can impair testicular function and reduce testosterone synthesis. The relationship is bidirectional, as low testosterone can also worsen insulin resistance and glycemic control. Symptoms of low testosterone in diabetic men may include:
- Decreased libido
- Erectile dysfunction
- Fatigue
- Reduced muscle mass
- Increased body fat
Treatment typically involves optimizing diabetes management through proper insulin therapy and blood sugar control, which may help improve testosterone levels, as recommended in the latest standards of care in diabetes-2024 1. In cases of confirmed hypogonadism, testosterone replacement therapy might be considered under medical supervision, with options including injections, transdermal gels, or patches. Regular monitoring of both testosterone levels and diabetes control is essential when managing these concurrent conditions, as emphasized in the guidelines 1. It is also important to consider the potential risks and benefits of testosterone replacement therapy, including the potential for increased coronary artery plaque volume and cardiovascular events, as noted in previous studies 1. However, the most recent and highest quality study 1 provides the most up-to-date guidance on this topic.
From the Research
Relationship Between Type 1 Diabetes and Low Testosterone
- The relationship between type 1 diabetes and low testosterone is not as well-established as it is for type 2 diabetes, but recent studies suggest that about 10% of men with type 1 diabetes mellitus (T1DM) suffer from hypogonadism, particularly aged men and men with obesity 2.
- A study found that men with T1DM and hypogonadism who received testosterone replacement therapy (TRT) showed improvements in glycemic control, lipid profiles, and erectile function 2.
- However, another study found that total testosterone levels were actually higher in adolescents and young men with T1D compared to controls, and that 24-h urine albumin level positively correlated with total testosterone levels 3.
- It is worth noting that the current evidence is mostly focused on type 2 diabetes, and the relationship between low testosterone and type 1 diabetes is not as well-studied 4, 5, 6.
- More research is needed to fully understand the relationship between type 1 diabetes and low testosterone, particularly in terms of the potential benefits and risks of testosterone replacement therapy in this population.
Key Findings
- Testosterone replacement therapy may improve glycemic control, lipid profiles, and erectile function in men with T1DM and hypogonadism 2.
- Total testosterone levels may be higher in adolescents and young men with T1D compared to controls 3.
- The relationship between low testosterone and type 1 diabetes is not as well-studied as it is for type 2 diabetes 4, 5, 6.
- More research is needed to fully understand the relationship between type 1 diabetes and low testosterone, particularly in terms of the potential benefits and risks of testosterone replacement therapy in this population.
Studies on Testosterone and Diabetes
- A study found that long-term testosterone therapy in men with hypogonadism and prediabetes prevents progression to type 2 diabetes 4.
- A systematic review found that testosterone replacement therapy improves body composition, insulin resistance, and glucose profile in men with impaired fasting glucose and type 2 diabetes mellitus 5.
- A study found that low testosterone is commonly associated with type 2 diabetes and metabolic syndrome, and that testosterone therapy alters the body composition in a metabolically favorable manner 6.