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 Table of Contents  
ORIGINAL ARTICLE
Year : 2014  |  Volume : 27  |  Issue : 4  |  Page : 758-761

Testosterone in type II diabetic men


1 Department of Dermatology, Andrology and Sexually Transmitted Diseases, Menoufia University, Menoufia, Egypt
2 Department of Medical Biochemistry, Faculty of Medicine, Menoufia University, Menoufia, Egypt
3 Department of Dermatology, Andrology, Sheben Elkom Educational Hospital, Menoufia, Egypt

Date of Submission10-Dec-2013
Date of Acceptance11-May-2014
Date of Web Publication22-Jan-2015

Correspondence Address:
Shimaa Ibrahim Aminelareef
Department of Dermatology, Andrology, Sheben Elkom Educational Hospital, brket-elsabaa, Menoufia
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1110-2098.149745

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  Abstract 

Objectives
This work aimed to detect the level of free testosterone (FT) hormone in type II diabetic men.
Background
Testosterone is a cholesterol-based steroid hormone that plays a critical role in numerous biological functions throughout the male life cycle. Diabetes mellitus type 2 is a metabolic disorder that is characterized by high blood glucose in the context of insulin resistance and relative insulin deficiency. Low serum testosterone is associated with a variety of comorbidities, including insulin resistance, type 2 diabetes, obesity, and metabolic syndrome.
Materials and methods
This study was carried out on 50 diabetic men aged from 25 to 65 years and 20 apparently healthy men, who attended the outpatient clinic of Dermatology, Andrology, and Sexually transmitted diseases.
Results
The lower levels of FT were found in older diabetic persons; diabetic men were markedly obese and showed higher BMI. They showed low International Index of Erectile Function scores, but higher scores were observed in young patients. The lowest FT levels were found in patients with the highest random blood sugar levels.
Conclusion
FT levels decrease as a man ages and if he is obese, his testosterone levels decrease even more. Diabetes accentuates these effects. Low testosterone level is a biomarker for diabetes development and high BMI is also highly predictive for development of diabetes.

Keywords: Diabetes mellitus, erectile dysfunction and obesity, testosterone


How to cite this article:
El wahed Ma, EL Shafi MK, Aminelareef SI. Testosterone in type II diabetic men. Menoufia Med J 2014;27:758-61

How to cite this URL:
El wahed Ma, EL Shafi MK, Aminelareef SI. Testosterone in type II diabetic men. Menoufia Med J [serial online] 2014 [cited 2020 Feb 17];27:758-61. Available from: http://www.mmj.eg.net/text.asp?2014/27/4/758/149745


  Introuduction Top


Testosterone is an anabolic-androgenic steroid hormone that is made in the testes in men and in the ovaries in women (a minimal amount is also made in the adrenal glands). Testosterone has two major functions in the human body [1].

Diabetes mellitus type 2 is a metabolic disorder that is characterized by high blood glucose in the context of insulin resistance and relative insulin deficiency [2].

A number of epidemiological studies support associations of obesity, the metabolic syndrome [3], type 2 diabetes [4], and low serum testosterone [5] with sexual dysfunction including erectile dysfunction (ED) [6]. These studies highlight the complex often multidirectional relationships among obesity, metabolic status, low testosterone, and ED in men.

International index of erectile function questionnaire

International Index of Erectile Function Questionnaire (IIEF) is a questionnaire that consists of 15 questions. These questions ask about the erection problems that have had on patient's sex life, following questions as honestly and clearly as possible. In answering these questions, the following definitions apply sexual activity, sexual intercourse, sexual stimulation, and ejaculate [7].

Thereafter, scoring algorithm for IIEF, clinical interpretation, scoring of those definitions, and then calculation of the score were performed.


  Materials and methods Top


This study was carried out on 50 diabetic men, aged from 25 to 65 years, who attended the outpatient clinic of Dermatology, Andrology, and Sexually transmitted diseases in Menofia University Hospital from March 2012 to April 2013. Twenty apparently healthy men aged from 25 to 65 years served as controls.

The patients were divided into the following groups:

Group I: it included 15 young diabetic men aged from 25 to 36 years.

Group II: it included 35 old diabetic men with age ranging from 36 to 65 years.

They were selected according to their ages and they were diabetic (type II):

The exclusion criteria were diabetes (type I), cardiovascular patients, and smoking.

Group III: it included 20 apparently healthy male volunteers aged from 25 to 65 years.

All patients and controls were subjected to the following (after taking ratification from every patient and the approval of the Ethics Committee):

  1. Complete history taking (subjective evaluation). It included personal history, complaint, and present history such as painful erection, painful ejaculation, past history of diseases, and family history.
  2. Objective evaluation: complete clinical examination (general and local).


Stressing upon

  1. Height and weight with calculation of the BMI (W) 2 /H.
  2. Blood pressure measurement.
  3. Genital examination.


Sample collection

  1. Five milliliter of venous blood was withdrawn by sterile vein puncture; 4 ml was transferred into a dry sterile centrifuge tube.
  2. The whole blood was allowed to clot at room temperature, then centrifuged for 10 min at 4000 rpm. The clear supernatant serum was separated from the clot and kept at -20°C until analysis of free testosterone (FT) by an enzyme immunoassay using ELISA kit [8].
  3. The other 1 ml of blood was transferred into sodium floride-containing tube for blood sugar estimation using Spinreact kit [9].



  Results Top


This study was carried out on 50 men as the patient group and 20 normal healthy men as a control group.

The results of the present study are presented in [Table 1],[Table 2],[Table 3],[Table 4] and [Table 5].
Table 1: Comparison of free testosterone levels between patients and controls

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Table 2: Comparison of random blood sugar between patients and controls

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Table 3: Comparison of BMI between patients and controls

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Table 4: Correlation between free testosterone levels and different parameters in patients and controls

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Table 5: Statistical comparison of different parameters according to age (years) in the patient group

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[Table 1] shows that there is a significant decrease in FT level in diabetic patients compared with the control group.

[Table 2] shows that there is a highly significant increase in random blood sugar (RBS) levels of patients compared with the control group.

[Table 3] shows that there is a significant difference in BMI of the patient group compared with the control group.

[Table 4] shows correlation between FT in the patient group and the controls and each of different parameters, which shows that there is significant negative correlation between FT and each of age, RBS, BMI, and the IIEF score.

[Table 5] shows statistical comparison of different parameters according to age in the patient group; there was significant statistical decrease in the level of FT and IIEF score in older age patients than in younger ones, whereas significant statistical increase existed regarding RBS and BMI.{Table 5}


  Discussion Top


In the present study, low FT in diabetic men leads to decrease in sexual function, desire, and ED, which agree with another study in 2007 [10] explaining that men with diabetes are more likely to develop erectile problems when their diabetes is not well controlled; long-term poor control may result in increased damage to the nerves and circulation that control blood flow to the penis. If blood glucose levels are kept in the normal range, it will help reduce the chance of occurrence of these problems [11].

It was reported that an increase in FT levels has also been found to occur in men who have orgasms that are masturbation-induced [12], which is in agreement with this study.

In the present study, there was a highly significant decrease in FT level in the diabetic group in comparison with the control group; these results agree with a new study that adds an interesting new wrinkle - fully one-third of the 103 men studied with type 2 diabetes had low total and FT levels [13].

There is a positive correlation between serum FT levels and insulin resistance in this study; the more the level of RBS, the lower the level of testosterone. Studies have shown the inverse association of testosterone with insulin resistance [10]. In this study, low testosterone level is a marker for the development of diabetes (low testosterone is merely a biomarker) [14].

In the present study and in a correlation between FT level and age among the diseased persons, it was reported that a man's testosterone levels decrease as he ages. If he is obese, his testosterone levels decrease even more. Diabetes accentuates these effects. The researchers found nothing wrong with the men's testes. Instead, they found evidence that the men's pituitary glands were not making enough luteinizing hormone, which is the hormone that tells the testes to make testosterone, and they refer this to the microvascular changes that occur as a complication of diabetes [15].

In another correlation between testosterone level and young diabetic men, the study showed that the more the age, the more the testosterone level decreases and vice versa. FT was negatively related to age, which agreed with the study by Ajayi and Halushka [15].

In this study, there is a marked increase in BMI among the diseased persons, particularly those who have low FT level.

A number of epidemiological studies support associations of obesity [16], the metabolic syndrome [17], type 2 diabetes [18], and low serum testosterone [8] with sexual dysfunction including ED [10]. These studies highlight the complex often multidirectional relationships between obesity, metabolic status, low testosterone, and ED in men. Obesity is a proinflammatory state resulting in increased release and secretion of proinflammatory cytokines and adipokines, free fatty acids, and estrogens from adipose tissue; these increases are important risk factors that may contribute to the development of metabolic syndrome and type II diabetes as well as androgen deficiency [19], which agree with this study.

Hence, from the present study, we can conclude the following:

  1. The level of testosterone hormone is highly dependent on severity of 'diabetes'; the level is decreased in men suffering from diabetes type 2 according to the level of the disease.
  2. There is a strong correlation between obesity and low testosterone level; with increasing obesity, testosterone level is decreased.
  3. IIEF score decreased when the level of testosterone is decreased.



  Acknowledgements Top


Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Cunningham GR, Toma SM. Clinical review: Why is androgen replacement in males controversial? J Clin Endocrinol Metab 2011; 96 :38-52.  Back to cited text no. 1
    
2.
Kumar V, Fausto N, Abbas AK, Cotran RS, Robbins SL. Robbins and Cotran Pathologic Basis of Disease. 7th ed. Philadelphia, PA: Saunders; 2005. 1194-1195.  Back to cited text no. 2
    
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Bajos N, Wellings K, Laborde C, Moreau CCSF Group. Sexuality and obesity, a gender perspective: results from French national random probability survey of sexual behaviours. BMJ 2010; 340 :2573.  Back to cited text no. 3
    
4.
Malavige LS, Levy JC. Erectile dysfunction in diabetes mellitus. J Sex Med 2009; 6 :1232-1247.  Back to cited text no. 4
    
5.
Wu FC, Tajar A, Beynon JM, Pye SR, Silman AJ, Finn JD et al. Identification of late-onset hypogonadism in middle-aged and elderly men. N Engl J Med 2010; 363 :123-135.  Back to cited text no. 5
    
6.
Allan CA, McLachlan RI. Androgens and obesity. Curr Opin Endocrinol Diabetes Obes 2010; 17 :224-232.  Back to cited text no. 6
    
7.
Rosen RC, Riley A, Wagner G, Osterloh IH, Kirkpatrick J, Mishra A. The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology 1997; 49 :822-830.  Back to cited text no. 7
    
8.
Ooi DS, et al. Establishing reference interval for DPC′s free testosterone radio immune assay clinc. Biochm 1998; 31: 15-21.  Back to cited text no. 8
    
9.
Burtis S, Rosa M, Bienv, Whicher J. In: Bruit C, Ashwood E, (editors). Role of the clinical laboratory in diabetes mellitus. Tiez text book of clinical chemistry. Chapter 25. 4th ed.; 2006. 837-903.   Back to cited text no. 9
    
10.
Gooren LJ, Behre HM, Saad F, Frank A, Schwerdt S. Diagnosing and treating testosterone deficiency in different parts of the world. Results from global market research. Aging Male 2007; 10 :173-181.  Back to cited text no. 10
    
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Nelson C. Acceptance and commitment therapy for erectile dysfunction following radical pros. Natl Cancer Inst 2011; 6 ;454-543.  Back to cited text no. 11
    
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Exton MS, Bindert A, Krüger T, Scheller F, Hartmann U, Schedlowski M. Cardiovascular and endocrine alterations after masturbation-induced orgasm in women. Psychosom Med 1999; 61 :280-289.  Back to cited text no. 12
    
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Dhindsa S, Prabhakar S, Sethi M, Bandyopadhyay A, Chaudhuri A, Dandona P. Frequent occurrence of hypogonadotropic hypogonadism in type 2 diabetes. J Clin Endocrinol Metab 2004; 89 :5462-5468.  Back to cited text no. 13
    
14.
Chandel A, et al. Testosterone concentrations in young patients with diabetes mellitus. Diabetes Care 2008; 80 :799-801.  Back to cited text no. 14
    
15.
Ajayi AA, Halushka PV. Castration reduces platelet thromboxane A2 receptor density and aggregability. QJM 2005; 98 :349-356.  Back to cited text no. 15
    
16.
Keating NL, O′Malley A, Freedland SJ, Smith MR. Diabetes and cardiovascular disease during androgen deprivation therapy: observational study of veterans with prostate cancer. J Natl Cancer Inst 2010; 102 :39-46.  Back to cited text no. 16
    
17.
Larsen SH, Wagner G, Heitmann BL. Sexual function and obesity. Int J Obes (Lond) 2007; 31 :1189-1198.  Back to cited text no. 17
    
18.
Bal K, Oder M, Sahi AS, Karataº CT, Demir O, Can E et al. Prevalence of metabolic syndrome and its association with erectile dysfunction among urologic patients: metabolic backgrounds of erectile dysfunction. Urology 2007; 69 :356-360.  Back to cited text no. 18
    
19.
Swerdloff R, Wang C. Testosterone treatment of older men - why are controversies created? J Clin Endocrinol Metab 2011; 96 :62-65.  Back to cited text no. 19
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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