Department of Medicine, Austin Health/Northern Health, University of Melbourne, Heidelberg, VIC 3084, Australia.
J Clin Endocrinol Metab. 2011 Aug;96(8):2341-53. doi: 10.1210/jc.2011-0118. Epub 2011 Jun 6.
The relationship between testosterone and diabetes in men is an important issue, given that one third of U.S. men aged 65 yr or older have diabetes, with a similar percentage having low testosterone levels.
The medical literature from 1970 to March 2011 was reviewed for key articles.
In population-based studies, low testosterone is commonly associated with type 2 diabetes and the metabolic syndrome, and it identifies men with an adverse metabolic profile. The difference in testosterone levels between men with diabetes compared to men without diabetes is moderate and comparable in magnitude to the effects of other chronic diseases, suggesting that low testosterone may be a marker of poor health. Although the inverse association of testosterone with diabetes is partially mediated by SHBG, low testosterone is linked to diabetes via a bidirectional relationship with visceral fat, muscle, and possibly bone. There is consistent evidence from randomized trials that testosterone therapy alters body composition in a metabolically favorable manner, but changes are modest and have not consistently translated into reductions in insulin resistance or improvements in glucose metabolism.
The key response to the aging, overweight man with type 2 diabetes and subnormal testosterone levels should be implementation of lifestyle measures such as weight loss and exercise, which, if successful, raise testosterone and provide multiple health benefits. Although approved therapy for diabetes should be used, testosterone therapy should not be given to such men until benefits and risks are clarified by adequately powered clinical trials.
男性的睾丸激素和糖尿病之间的关系是一个重要的问题，因为三分之一的美国 65 岁或以上的男性患有糖尿病，而同样比例的男性睾丸激素水平较低。
对 1970 年至 2011 年 3 月的医学文献进行了综述，以获取关键文章。
在基于人群的研究中，低睾丸激素通常与 2 型糖尿病和代谢综合征相关，它确定了具有不良代谢特征的男性。与没有糖尿病的男性相比，糖尿病男性的睾丸激素水平差异适中，与其他慢性疾病的影响相当，这表明低睾丸激素可能是健康状况不佳的标志。虽然睾丸激素与糖尿病的负相关部分是由 SHBG 介导的，但低睾丸激素与糖尿病之间存在双向关系，与内脏脂肪、肌肉和可能的骨骼有关。随机试验的一致证据表明，睾丸激素治疗以代谢有利的方式改变身体成分，但变化是适度的，并没有一致转化为胰岛素抵抗的降低或葡萄糖代谢的改善。
对于超重、患有 2 型糖尿病和睾丸激素水平低下的老年男性，关键的反应应该是采取生活方式措施，如减肥和锻炼，如果成功，这些措施可以提高睾丸激素水平，并提供多种健康益处。尽管应该使用批准用于治疗糖尿病的疗法，但在通过充分的临床试验明确获益和风险之前，不应给予此类男性睾丸激素治疗。
