Testosterone has had a disreputable reputation in the past and has been associated with body builders’ muscles, but now it is
associated with beating diabetes.
Like many Type 2 diabetics, when he was first diagnosed Charles Lawson was overweight – and despondent.
‘I’d just lost my oomph,’ recalls the 68-year-old teacher. ‘The nurse at my GP practice suggested diet and exercise, but my waistline just kept expanding. I was falling asleep all the time and I’d even stopped gardening, which I love.’
But while most patients would be prescribed drugs such as metformin to reduce high sugar levels to tackle these symptoms, Charles was offered a radical new treatment – the male hormone testosterone. This was not to improve his libido, but because new research shows that giving testosterone can improve some of the symptoms of diabetes.
There are around one-and-half million men in the UK with Type 2 diabetes (the type linked with poor diet and lack of exercise). Around 40 per cent of men with Type 2 diabetes had low testosterone levels, according to a study published last year by Professor Testosterone patch beats diabetes (and boosts libido!).
Hugh Jones, an endocrinologist at Barnsley Hospital
Exactly why low testosterone is linked to diabetes isn’t clear, but the fact that low testosterone increases the amount of damaging
visceral fat – typical middle-age spread – probably plays a part. And if you have diabetes and your level of testosterone is very low, there’s evidence testosterone replacement can help. The bonus is that you’re also likely to see your libido improve. Last year, a study of 48 men with diabetes and low testosterone found that 80 per cent of those getting hormone treatment as well as the usual diabetes drugs managed to get their blood sugar levels, their body’s resistance to insulin, and weight down to healthy levels.
Erectile dysfunction is a common problem among men who have diabetes
‘Usually men only get given testosterone if they complain of erectile dysfunction and they haven’t responded to a pill like Viagra,’ says
Dr David Edwards, an Oxford GP with a specialist interest in sexual medicine. ‘But supplementing with testosterone is no longer a matter of giving a sexual boost; low testosterone is a preventable risk that needs to be treated.’ Even though Charles hadn’t complained about erection problems, Dr Edwards checked his testosterone level, along with his blood sugar level, blood pressure and cholesterol.
Sufferers of Type 2 diabetes tend to put on weight
When his testosterone showed up as very low, he was put on testosterone gel to use every day (patients may also be given a testosterone patch which is changed every month). He’s been delighted with the results. ‘It’s true that my libido had been pretty non-existent, but that wasn’t the main problem for me, which is why I didn’t mention it,’ says Charles. ‘What was making my life a misery was I’d lost all my feeling of get-up-and-go.’ All that changed soon after starting on the testosterone. ‘I gradually began to feel more active and positive in general. I found I could
do more exercise and I was able to stick to my diet. ‘As a result, my weight started to go down and I lost four centimetres from round my middle. My blood sugar control improved, too.’ And he had the added benefit of a boost to his libido. ‘It was like a two-for-one treatment. When I started on the testosterone, my wife said she was worried I’d become all sex obsessed and run off with a younger woman. That didn’t happen, but I did get back some of my old sparkle.’
Diabetes is not the only condition linked to low testosterone levels in men. A recent trial of 800 men over 50 at the University of California San Diego showed that having low testosterone raises the risk of death from heart disease and deaths from all causes. After following the patients for 20 years, the scientists found that those with the lowest levels were 40 per cent more likely to die than those with the most. ‘What this means is that if you don’t treat patients with low testosterone, whether they’ve got diabetes or not, there is a good chance they are going to die sooner,’ says Dr Edwards.
However, this is still a highly controversial approach. Although testosterone supplements have been available for more than 60 years, the hormone still has a disreputable reputation and is associated with oversexed, body builders’ muscles and ‘ roid rages’. There are also concerns about side effects such as a raised risk of prostate cancer (dismissed recently by the International Society of Andrologyand the European Association of Urology). As a result, many doctors are reluctant to prescribe testosterone. Their attitude is that if it is associated with diabetes at all it is usually only because diabetes patients are more likely to have erectile problems anyway. ‘There’s insufficient evidence that low testosterone increases risk of heart and circulatory disease,’ said a spokesperson for the British Heart Foundation. ‘We couldn’t recommend routine testing for men. We are not funding any trials to investigate the connection.’ But the important point is that ‘we are not talking about giving super high levels’, says Dr Edwards. ‘The fairly small number of diabetic men who I’ve treated so far have very low levels to start with.
You are treated if you are below eight – a normal level is 12 or over. Anything extra doesn’t help with the metabolic syndrome – a combination of symptoms that increase your risk of developing diabetes or cardiovascular disease.’ Diabetes UK takes a neutral position over whether testosterone might help with the disease. ‘We wouldn’t recommend testing but we wouldn’t not recommend it either,’ said a spokesperson. ‘There’s a tenuous connection between diabetes and low testosterone but it needs more research. If a man had erectile dysfunction then he should be tested. This is something that has to be done on an individual basis.’