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Testosterone and the prevention of type 2 diabetes mellitus: therapeutic implications from recent trials

Gary Wittert1, Mahesh M Umapathysivam1,2

  • 1Freemasons Centre for Male Health and Wellbeing, South Australian Health and Medical Research Institute, University of Adelaide, Adelaide.

Current Opinion in Endocrinology, Diabetes, and Obesity
|September 17, 2024
PubMed
Abstract

Insights

Testosterone treatment can prevent Type 2 diabetes (T2D) in high-risk men, particularly when combined with lifestyle changes. However, results vary, and other treatments may be more suitable for some individuals.

Area of Science:

  • Endocrinology
  • Metabolic Diseases
  • Clinical Trials

Background:

  • Type 2 diabetes (T2D) prevalence is rising globally, often linked to obesity and low testosterone in men.
  • Low serum testosterone is a common comorbidity in men with obesity and T2D.

Purpose of the Study:

  • To review recent randomized controlled trials (RCTs) on testosterone treatment's impact on glycemic control and T2D prevention.
  • To evaluate the efficacy of testosterone therapy in managing T2D risk factors.

Main Methods:

  • Systematic review of recent randomized controlled trials (RCTs).
  • Analysis of studies investigating testosterone's effects on glucose metabolism, insulin sensitivity, and T2D incidence.
  • Inclusion of trials with varying patient demographics and intervention durations.

Main Results:

  • The T4DM trial showed a 40% reduction in T2D risk with testosterone treatment plus lifestyle intervention in older men with visceral obesity and impaired glucose tolerance.
  • Some studies indicated modest improvements in insulin sensitivity and body composition with testosterone therapy.
  • Other trials found no significant glycemic benefits, highlighting variability in outcomes.

Conclusions:

  • Testosterone therapy can prevent T2D in high-risk men, but its application has limitations.
  • Variations in trial design, patient populations, and outcome measures (e.g., HbA1c) contribute to inconsistent findings.
  • Future research should investigate testosterone synergies with GLP-1 receptor agonists and assess cost-effectiveness for T2D management.

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