Abstract
Background: Epidemiological studies have shown that low testosterone levels are an independent risk factor for type-2 diabetes (T2DM). The risk of both hypogonadism and T2DM increases with age.
Aims and Objectives: To evaluate and study the relationship of serum testosterone level with conventional risk factors for atherosclerosis, duration of diabetes and HbA1c in T2DM patients.
Materials and Methods: A total 120 subjects were studied after dividing them in to Cases (T2DM male patients, n=80) and Control (sex matched healthy male subjects, n=40) at Dept. of Medicine, G R Medical College & J.A. Group of Hospitals, Gwalior, between September 2011 and October 2012. Study cohort were studied based on the detailed history, anthropometric measurements, relevant blood investigations, HbA1C, ECG changes and estimation of serum total (STT) and free testosterone (SFT).
Results: Majority of the cases belonged to age group of 41-50 years (40%). Mean serum total testosterone (STT) (300.72±33.14 vs383.81±57.63, p=0.551) and serum free testosterone (SFT) (7.65±2.04 vs. 11.17±2.30, p=0.002) levels were lower among Cases compared to Control. Among Cases and Control, 28.75% and 25% subjects had decreased STT (p=0.020) whereas 57.5% and 25% subjects had decreased SFT (p=0.029) respectively. Among Cases out of 26 obese patients, 76.9% had low level of SFT whereas in Control group, out of 10 obese subjects 40% had low level of SFT. All the patients [18 (22.5%)] among cases who had total cholesterol ≥200 mg/dl had low level of SFT whereas among Control group, 50% out of 6 subjects had low level of SFT (p=0.015) Out of 53 patients who had TG ≥150 mg/dl, 67.92% had low level of SFT whereas in control group, out of 10 subjects, 30% subjects had low level of SFT (p= 0.0019). Out of 55 patients in cases and 13 subjects in Control who had HDL-C <40 mg/dl, 32 patients (58.18%) and 4 subjects (30.76%) had low level of SFT respectively (p<0.001).Among the patient with T2DM for >5 years (n=28), 12 (42.85%) and 18 (64.28%) had low levels of STT and SFT respectively. In cases with 2 or lesser risk factors for CAD, 5.26% and 42.16% patients had low level of STT and SFT respectively. In cases with 3 or more risk factors for CAD, 50% and 71.42% patients had low level of STT and SFT respectively.
Conclusion: Testosterone deficiency is common in T2DM patients who were in 4th and 5th decade of their life. Low serum free testosterone in T2DM patients was associated with reduced sexual desire, low HDL, increased BMI, high serum triglyceride, increase total cholesterol and LDL levels. Low serum free testosterone is also significantly associated with increased risk of CAD in T2DM patients.
Keywords: Testosterone deficiency, CAD, lipid profile, serum free testosterone
References
- Dhindsa S, Prabhakar S, Sethi M, Bandyopadhyay A, Chaudhuri A, Dandona P. Frequent Occurrence of Hypogonadot-ropic Hypogonadism in Type 2 Diabetes. The Journal of Clinical Endocrinology and Metabolism 2004; 11: 5462-8.
- Tomar R, dhindsa S, choudhary A. Contrasting testosterone concentration in type 1 and type 2 diabetes. Diabetes Care 2006: 29:1120-2.
- Eckel RH. The Metabolic Syndrome Harrison’s principles of internal medicine 18th edition 2012;242 (2):1992-1997
- British Heart Foundation Statistics Database. BHF 1996: 21–2.
- English KM, Mandour O, Steeds RP, Diver MJ, Jones TH, Channer KS. Men with coronary artery disease have lower levels of androgens than men with normal coronary angiograms. Eur Heart J 2000; 21; 890–4.
- Hak AE, Witteman JCM, De Jong FH, Geerlings MI, Hofman A, Pols HAP. Low levels of endogenous androgens increase the risk of atherosclerosis in elderly men: The Rotterdam study. J Clin Endocrinol Metab 2002: 87:3632–9.
- Bhatia V, Chaudhuri A, Tomar R, Dhindsa S et al. Low Testosterone and High C-Reactive Protein Concentrations Predict Low Hematocrit. Diabetes Care 2006;29: 10.
- Guay A, Spark R, Bansal S, Goodman N, Petak S. American Association of Clinical Endocrinologists medical guidelines for clinical practice for the evaluation and treatment of male sexual dysfunction: a couple's problem--2003 update. Endocr Pract 2003;9: 77–95.
- Koopman RJ, Mainous A G, Diaz V A, Geesey M E; Changes in Age at Diagnosis of Type 2 Diabetes Mellitus in the United States, 1988 to 2000 . Ann Fam Med 2005;3:60-63.
- Gale, Jason (November 7, 2010).India’s Diabetes Epidemic Cuts Down Millions Who Escape Poverty "Bloomberg.
- Ernani L. Rhoden, Eduardo P. Ribeiro, Claudio Teloken, Carlos A.V. Souto; Diabetes mellitus is associated with subnormal serum levels of free testosterone in men. BJU International 2005;96:867–70.
- Kapoor D, Clarke S, Channer KS, Jones TH. Erectile dysfunction is associated with low testosterone levels and visceral adiposity in men with type 2 diabetes. Int. J. Androl 2007; 10: 1365-2605
- Chandel A, Dhindsa S, Topiwala S, Chaudhuri A, Dandona P. Testosterone Concentration in Young Patients With Diabetes New York Source: Diabetes Care 2008;31:2013 .
- Mathis Grossmann. Low Testosterone Levels are Common and Associated with Insulin Resistance in Men with Diabetes. Journal of Clinical Endocrinology & Metabolism, 2008; 93: 1834-40.
- Fedele D, Bortolotti A, Coscelli C, Santeusanio F, Chatenoud L, Colli E et al. Erectile dysfunction in type 1 and type 2 diabetics in Italy: on behalf of GruppoItaliano Studio Deficit Erettilenei Diabetici. Int J Epidemiol 2000, 29:524–31.
- Dhindsa S, Miller MG, McWhirter CL, Mager DE. Testosterone Concentrations in Diabetic and Nondiabetic Obese Men. Diabetes Care 2010; 33: 1186
- Giagulli VA, Kauf man JM, Vermeulen A. pathogenesis of the decreased androgen levels in obese men. J Clin. Endocrinal. Metab 1994; 79: 929-31.
- Majon Mulle. Endogenous sex hormones and Cardiavascular disease in men. J Clin Endocrinol Metab 2003;88:5076-86. Mathis Grossmann; Low Testosterone Levels are Common and Associated with Insulin Resistance in Men with Diabetes. Journal of Clinical Endocrinology & Metabolism, 2008; 93: 1834-1840.
- Umoh U. Charles-Davies MA, Adeleye J. Serum testosterone and lipids in relation to sexual dysfunction in males with metabolic syndrome and type2 diabetes mellitus ; International Journal of Medicine and Medical Sciences;dec 2012; 2(12):402-12.
- Khan I, Kant C, Samaria A. Assessment of Hypogonadism with Reference to Clinical Features and Serum Testosterone Levels in Asian-Indian Male Type 2 Diabetics; Indian Journal of Clinical Practice 2012; 23 (2): 92-9.
- Farnkvist LM, Lundman BM. Outcomes of diabetes care: a population-based study. Int J Qual Health Care 2003:15: 301-7.
Corresponding Author
Dr Piyush Gosar
Room no. 29, PG Hostel, JAH, GRMC, Gwalior, MP, India
Email: This email address is being protected from spambots. You need JavaScript enabled to view it., Mob: 7024502270
DOI: https://dx.doi.org/10.18535/jmscr/v6i8.105
