Yu Xiaowei, Wei Zhentong, Liu Yanhong, Zhang XiaoYuan, Wang Qun
Department of Reproductive Medicine, Department of Prenatal Diagnosis, The First Hospital of Jilin University, Changchun, Jilin, China.
Department of Obstetrics and Gynecology, The First Hospital of Jilin University, Changchun, Jilin, China.
Sex Med. 2021 Aug;9(4):100403. doi: 10.1016/j.esxm.2021.100403. Epub 2021 Jul 20.
Testosterone can improve glucose metabolism through multiple cellular mechanisms. However, it remains unclear as to whether hypogonadal men with type 2 diabetes mellitus (T2DM) can benefit from testosterone replacement therapy (TRT).
To assess the relative effect of TRT on glycolipid metabolism among hypogonadal men with T2DM.
Electronic literature searches of the Cochrane Library, PubMed, MEDLINE, and EMBASE databases were conducted, up to the end of October 2020. Only studies that used randomized controlled trials (RCTs) were included in our systematic review. Main outcome measures From these studies, we extracted certain outcomes including changes in insulin resistance, glucose metabolism, and lipid parameters.
There were a total of 8 studies that met our criteria. Four of these studies either did not have a consistent treatment strategy, or the control groups used untreated patients rather than patients that had been given a placebo. Thus, results from these four studies contributed to the variability in treatment outcomes. In four of the examined RCTs, there was no change in either the dose or the type of antidiabetic medication prescribed. Based on the homeostatic model assessment of insulin resistance, the pooled WMD was -0.34, 95% confidence interval (CI; -1.02, 0.34), P = .33; For fasting plasma glucose, the pooled WMD was -0.27, 95% CI (-1.02, 0.48), P = .48, the pooled WMD for HbA1c% was -0.00, 95% CI (-1.08, 1.08), P = 1.00.
Although certain RCTs showed that TRT improved insulin resistance and glycolipid metabolism when compared with the placebo or untreated control groups, these findings may partly be due to changes in antidiabetic therapy during the course of the study. In the current meta-analysis, analyses showed that TRT did not significantly improve insulin resistance or glycolipid metabolism. Future studies need to be rigorous in design and delivery, and comprehensive descriptions of all aspects of their methods should be included to further enable a more accurate appraisal and interpretation of the results. Yu X, Wei Z, Liu Y, et al. Effects of Testosterone Replacement Therapy on Glycolipid Metabolism Among Hypogonadal Men with T2DM: A Meta-Analysis And System Review Of Randomized Controlled Trials. Sex Med 2021;9:100403.
睾酮可通过多种细胞机制改善糖代谢。然而，2型糖尿病（T2DM）性腺功能减退男性是否能从睾酮替代疗法（TRT）中获益仍不清楚。
评估TRT对T2DM性腺功能减退男性糖脂代谢的相对影响。
截至2020年10月底，对Cochrane图书馆、PubMed、MEDLINE和EMBASE数据库进行了电子文献检索。我们的系统评价仅纳入使用随机对照试验（RCT）的研究。主要结局指标 从这些研究中，我们提取了某些结局指标，包括胰岛素抵抗、糖代谢和血脂参数的变化。
共有8项研究符合我们的标准。其中4项研究要么没有一致的治疗策略，要么对照组使用未治疗的患者而非给予安慰剂的患者。因此，这4项研究的结果导致了治疗结局的变异性。在4项纳入研究的RCT中，所开抗糖尿病药物的剂量或类型均无变化。基于胰岛素抵抗的稳态模型评估，合并加权均数差（WMD）为-0.34，95%置信区间（CI；-1.02，0.34），P = 0.33；空腹血糖的合并WMD为-0.27，95%CI（-1.02，0.48），P = 0.48，糖化血红蛋白（HbA1c）百分比的合并WMD为-0.00，95%CI（-1.08，1.08），P = 1.00。
尽管某些RCT表明，与安慰剂或未治疗的对照组相比，TRT可改善胰岛素抵抗和糖脂代谢，但这些发现可能部分归因于研究过程中抗糖尿病治疗的变化。在当前的荟萃分析中，分析表明TRT并未显著改善胰岛素抵抗或糖脂代谢。未来的研究在设计和实施上需要严谨，并应包括对其方法各方面的全面描述，以进一步实现对结果更准确的评估和解读。于X，魏Z，刘Y等。睾酮替代疗法对T2DM性腺功能减退男性糖脂代谢的影响：一项随机对照试验的荟萃分析和系统评价。性医学2021；9：100403。
