The influence of correction of carbohydrate metabolism and body weight on endogenous testosterone production in men with type 2 diabetes mellitus, obesity and hypogonadism

Abstract

Male hypogonadism and type 2 diabetes mellitus (T2DM) are often combined and aggravate each other. Considering the pathogenetic relationship with the components of the metabolic syndrome (hyperglycemia, insulin resistance, obesity) and the potential reversibility of testosterone deficiency, as well as the wariness of doctors and patients regarding testosterone replacement therapy, it is interesting to study the effect of various methods for correcting carbohydrate metabolism and obesity on endogenous testosterone production. When analyzing the effect of lifestyle correction, drug therapy for T2DM and obesity, as well as metabolic surgery on testosterone production, encouraging results were obtained with regard to methods that provide, first of all, significant reduction in body weight (medications from the group of glucagon-like peptide-1 receptor agonists and bariatric surgery). As for other classes of new antidiabetic drugs, it is likely that all of them may have direct or indirect beneficial effects on male sexual function, mainly by reducing glucotoxicity and inflammation. However, this hypothesis requires studies on large samples of patients. In addition, there is still no convincing data on the significance of correction of carbohydrate metabolism, regardless of weight loss, in relation to endogenous testosterone production, and there is also no data on the degree of improvement in glycemic control required for a clinically significant increase in serum testosterone levels.