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New patients joining the ON MEN online testosterone replacement therapy (TRT) community have excellent questions when assessing the best testosterone replacement therapy for them: “What is testosterone therapy going to look like in my body’s unique context, and does testosterone therapy have side effects that might interact with any other pre-existing conditions I might have?” For men with type 2 diabetes the answers may surprise you! First let’s talk about the condition of low testosterone (hypogonadism) and then we will explore the specific approaches to TRT that are best for type 2 diabetics. Get a blood test with ON MEN today, and see if you’re a good candidate for testosterone replacement therapy yourself by clicking here!
Testosterone therapy has been used to treat patients who have the condition of hypogonadism since the early 1960s. Hypogonadism results from a chronic androgen deficiency, which can be genetic or occur later in life, with all sorts of variations depending on the associated symptoms. (1) Testosterone deficiency is common in men with type 2 diabetes mellitus.
Testosterone becomes estradiol through a process called aromatisation, which happens around fat tissue. Diabetic men have more adipocytes (cells for storing fat in connective tissue), so their testosterone levels can drop and become suppressed because they have a greater aromatization process turning their T to estradiol, which then causes them to get hypogonadism. Low testosterone levels can, in turn, increase insulin resistance, fat retention, and vascular problems. In an example of the results of low testosterone’s interaction with type 2 diabetes, there is a study of hypogonadal men with type 2 diabetes who were monitored while having to go through androgen deprivation therapy to manage cancer. These men saw a sharp withdrawal of testosterone and a corresponding increase in insulin resistance. (2)
There is good news for men who have both type 2 diabetes and also have hypogonadism! Testosterone Replacement Therapy is likely to improve control over blood sugar levels and insulin. (3) TRT reducing insulin resistance has been studied since 1992 and there are three studies which showed TRT reduced insulin resistance. The reason for TRT’s assistance with type 2 diabetes’ insulin resistance is that testosterone stimulates the muscles and fat tissues to uptake sugar via the Glut4 insulin transporter, which then carries sugar to the insulin receptors. Men with type 2 diabetes show reduced Glut4 levels, but testosterone likely elevates Glut4 levels. So, essentially men with type 2 diabetes can invigorate their glucose uptake cycle by increasing their testosterone levels with TRT.
There are also some other interesting benefits of TRT surrounding reduction of fat. Diabetic men have greater adipocytes which makes it easier for them to gain fat, but Testosterone Replacement Therapy has been shown to reduce fat significantly. A European study (4) found that men lost fat especially around the waist, and their overall percentage of body fat was reduced. They also found that TRT decreases leptin and adiponectin levels in men with type 2 diabetes and hypogonadism. TRT also helpfully reduces triglyceride levels, though there is inconsistent evidence about if TRT will assist with cholesterol levels. However, in a study showing an example of the opposite situation, where men’s androgens were suppressed, LDL (the type of cholesterol you want lower levels of) levels were higher and HDL (helpful cholesterol) were lowered. That implies that androgens are important for lowering LDL and raising HDL.
Many new ON MEN clients ask: “Is testosterone replacement therapy dangerous? Does testosterone therapy have side effects? What are the benefits of TRT?” For men with type 2 diabetes, androgen replacement therapy is likely to be overall helpful for managing insulin resistance. However there is a specific protocol requirement for type 2 diabetics, surrounding a common hair loss medication for men usually paired with TRT. During testosterone replacement therapy the high testosterone will have a side effect of male pattern baldness, so many non-diabetic patients take DHT blockers (such as finasteride and minoxidil) to stop this side effect. However, for men with type 2 diabetes it is not a good idea to take DHT blockers while doing TRT. DHT may cause hair loss, but it is likely that testosterone turning into DHT could be part of the even more important for health uptake cycle of glucose. Ordering blood work from ON MEN will give you an in-depth readout of 20+ markers that can help move you forward on your journey to finding your ultimate body balance.