Departments of Endocrinology and Metabolism.
Departments of Radiology, Odense University Hospital, Odense, Denmark.
Eur J Endocrinol. 2017 Aug;177(2):157-168. doi: 10.1530/EJE-17-0071. Epub 2017 May 18.
Men with type 2 diabetes mellitus (T2D) often have lowered testosterone levels and an increased risk of cardiovascular disease (CVD). Ectopic fat increases the risk of CVD, whereas subcutaneous gluteofemoral fat protects against CVD and has a beneficial adipokine-secreting profile.
Testosterone replacement therapy (TRT) may reduce the content of ectopic fat and improve the adipokine profile in men with T2D.
A randomized, double-blinded, placebo-controlled study in 39 men aged 50-70 years with T2D and bioavailable testosterone levels <7.3 nmol/L. Patients were randomized to TRT ( = 20) or placebo gel ( = 19) for 24 weeks. Thigh subcutaneous fat area (TFA, %fat of total thigh volume), subcutaneous abdominal adipose tissue (SAT, % fat of total abdominal volume) and visceral adipose tissue (VAT, % fat of total abdominal volume) were measured by magnetic resonance (MR) imaging. Hepatic fat content was estimated by single-voxel MR spectroscopy. Adiponectin and leptin levels were measured by in-house immunofluorometric assay. Coefficients () represent the placebo-controlled mean effect of intervention.
TFA ( = -3.3 percentage points (pp), = 0.009), SAT ( = -3.0 pp, = 0.006), levels of adiponectin ( = -0.4 mg/L, = 0.045), leptin ( = -4.3 µg/mL, < 0.001), leptin:adiponectin ratio ( = -0.53, = 0.001) and HDL cholesterol ( = -0.11 mmol/L, = 0.009) decreased during TRT compared with placebo. Hepatic fat content and VAT were unchanged.
The effects of TRT on cardiovascular risk markers were ambiguous. We observed potentially harmful changes in cardiovascular risk parameters, markedly reduced subcutaneous fat and unchanged ectopic fat during TRT and a reduction in adiponectin levels. On the other hand, the decrease in leptin and leptin:adiponectin ratio assessments could reflect an amelioration of the cardiovascular risk profile linked to hyperleptinaemia in ageing men with T2D.
2 型糖尿病（T2D）男性常伴有睾酮水平降低和心血管疾病（CVD）风险增加。异位脂肪增加 CVD 风险，而臀股皮下脂肪可预防 CVD，并具有有益的脂肪因子分泌谱。
睾酮替代疗法（TRT）可能会减少 T2D 男性的异位脂肪含量并改善脂肪因子谱。
一项纳入 39 名年龄在 50-70 岁之间、生物可利用睾酮水平<7.3nmol/L 的 T2D 男性的随机、双盲、安慰剂对照研究。患者随机分为 TRT（n=20）或安慰剂凝胶（n=19）治疗 24 周。通过磁共振（MR）成像测量大腿皮下脂肪面积（TFA，大腿总容量的脂肪百分比）、腹部皮下脂肪组织（SAT，腹部总容量的脂肪百分比）和内脏脂肪组织（VAT，腹部总容量的脂肪百分比）。通过单体素 MR 光谱法估计肝内脂肪含量。通过内部免疫荧光测定法测量脂联素和瘦素水平。系数（）表示干预的安慰剂对照平均效应。
TFA（=-3.3 个百分点（pp），=0.009）、SAT（=-3.0pp，=0.006）、脂联素水平（=-0.4mg/L，=0.045）、瘦素（=-4.3μg/mL，<0.001）、瘦素：脂联素比值（=-0.53，=0.001）和高密度脂蛋白胆固醇（=-0.11mmol/L，=0.009）在 TRT 期间较安慰剂下降。肝内脂肪含量和 VAT 无变化。
TRT 对心血管风险标志物的影响并不明确。我们观察到在 TRT 期间，心血管风险参数可能发生有害变化，明显减少了皮下脂肪，但异位脂肪无变化，脂联素水平降低。另一方面，瘦素和瘦素：脂联素比值的降低可能反映了 2 型糖尿病老年男性中与高瘦素血症相关的心血管风险特征的改善。
