Wittert Gary, Umapathysivam Mahesh M
Freemasons Centre for Male Health and Wellbeing, South Australian Health and Medical Research Institute, University of Adelaide, Adelaide.
Southern Adelaide Diabetes and Endocrine Service, Adelaide, South Australia, Australia.
Curr Opin Endocrinol Diabetes Obes. 2024 Dec 1;31(6):243-248. doi: 10.1097/MED.0000000000000884. Epub 2024 Sep 9.
Type 2 diabetes (T2D) is increasing to epidemic proportions and frequently associated with obesity and a low serum testosterone concentration in men. This review valuates recent randomized controlled trials (RCTs) investigating the effect of testosterone treatment on glycemic control and T2D prevention.
The 2-year Testosterone for the Prevention of Type 2 diabetes Trial (T4DM) study showed that in men aged 50 years and over with visceral obesity and impaired glucose tolerance, testosterone treatment on the background of a lifestyle intervention reduced T2D risk by 40%. The Testosterone Effects on Atherosclerosis Progression in Aging Men and Testosterone Trials demonstrated modest improvements in insulin sensitivity and body composition. However, the Testosterone Replacement Therapy for Assessment of Long-Term Vascular Events and Efficacy Response in Hypogonadal Men trial found no significant glycemic benefits over 2 years. Recent data from the Diabetes Prevention Program Outcome Study support the cost efficacy and durability of metformin.
In men at high risk of T2D, treatment with testosterone prevents the disease; however, there are caveats to its use and other approaches may be more applicable. Differences in trial designs, age groups, and outcome measures contribute to varying results. HbA1C is a suboptimal outcome measure. Future research should explore potential synergies between testosterone and GLP-1 receptor agonists in T2D management, while considering cost-effectiveness.
2型糖尿病（T2D）正呈流行趋势，且在男性中常与肥胖及血清睾酮浓度降低相关。本综述评估了近期调查睾酮治疗对血糖控制及T2D预防效果的随机对照试验（RCT）。
为期2年的睾酮预防2型糖尿病试验（T4DM）研究表明，在50岁及以上伴有内脏肥胖和糖耐量受损的男性中，在生活方式干预的基础上进行睾酮治疗可使T2D风险降低40%。睾酮对老年男性动脉粥样硬化进展的影响及睾酮试验显示胰岛素敏感性和身体成分有适度改善。然而，性腺功能减退男性长期血管事件评估及睾酮替代疗法疗效反应试验发现，2年内未观察到显著的血糖益处。糖尿病预防计划结局研究的最新数据支持二甲双胍的成本效益和持久性。
在T2D高危男性中，睾酮治疗可预防该病；然而，其使用存在一些注意事项，其他方法可能更适用。试验设计、年龄组和结局指标的差异导致结果各异。糖化血红蛋白（HbA1C）是一个不太理想的结局指标。未来研究应探索睾酮与胰高血糖素样肽-1（GLP-1）受体激动剂在T2D管理中的潜在协同作用，同时考虑成本效益。
