Hayes Frances J
Boston, MA.
Trans Am Clin Climatol Assoc. 2025;135:297-305.
Given that low testosterone levels predict type 2 diabetes mellitus (T2DM) in men, we sought to dissect the relationship between testosterone and insulin sensitivity in men. We showed a positive correlation between serum testosterone levels and insulin sensitivity in men across the full spectrum of glucose tolerance. Men with hypogonadal testosterone levels were twice as insulin resistant as eugonadal controls. By dissecting the hypothalamic-pituitary-gonadal axis, we demonstrated that the cause of low testosterone was a decrease in testicular responsiveness to luteinizing hormone (LH). Using functional and genetic studies, we provided evidence that hypogonadism may induce insulin resistance by causing mitochondrial dysfunction. We also showed that weight loss can increase testosterone levels and reverse hypogonadism in over 50% of obese men with impaired glucose tolerance. We concluded that the relationship between testosterone and insulin resistance in men is bidirectional. Our data emphasized the importance of lifestyle modification as a key therapeutic step in the management of the hypogonadal male.
鉴于低睾酮水平可预测男性2型糖尿病（T2DM），我们试图剖析男性体内睾酮与胰岛素敏感性之间的关系。我们发现，在糖耐量的整个范围内，男性血清睾酮水平与胰岛素敏感性呈正相关。性腺功能减退的男性的胰岛素抵抗是性腺功能正常的对照组的两倍。通过剖析下丘脑-垂体-性腺轴，我们证明低睾酮的原因是睾丸对促黄体生成素（LH）的反应性降低。通过功能和基因研究，我们提供了证据表明性腺功能减退可能通过导致线粒体功能障碍而诱发胰岛素抵抗。我们还表明，体重减轻可使超过50%的糖耐量受损的肥胖男性的睾酮水平升高并逆转性腺功能减退。我们得出结论，男性体内睾酮与胰岛素抵抗之间的关系是双向的。我们的数据强调了生活方式改变作为性腺功能减退男性管理中关键治疗步骤的重要性。
