[Plasma testosterone, obesity, metabolic syndrome and diabetes]

The frequency of diabetes and/or metabolic syndrome rises concurrently with that of body mass index (BMI). In adult men, plasma testosterone level changes evolve inversely to that of BMI. Plasma total testosterone, sex hormone-binding globulin (SHBG) and free testosterone are significantly lower in adult men with a clinical and biological pattern of metabolic syndrome (MetS) than in those without such a pattern. After adjustment for confounding factors, diabetes type 2 (DT2) remains associated with a significant decrease of plasma testosterone level. The androgenic blockade, used as a treatment for disseminated prostate cancer, induces a metabolic pattern similar to MetS. In men older than 65 years, a decrease of plasma testosterone level is associated with an increased risk of stroke or of death linked to a cardiovascular event. After exclusion of contraindications, the substitution with androgens of a demonstrated hypogonadism in a obese patient, notably when obesity is associated with a pattern of MetS and/or a DT2, could have some metabolic and cardiovascular advantages.