TRT and the Management of T2D

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Two studies recently in the news show the effectiveness of testosterone replacement therapy in the management of tupe 2 diabetes. The first was presented at the Endocrine Society Annual Meeting.

An observational registry study of 462 men with obesity and hypogonadism. Among the cohort, 273 men (mean age, 59.8 years) took injections of testosterone undecanoate 1,000 mg for 12 weeks while 189 men (mean age, 63.5 years) did not undergo testosterone therapy and were considered the control group. Median follow-up was 9 years for the testosterone group and 8 years for the control group.

Based on measurements that were taken between one and four times per year, the researchers found that over the course of 10 years, men who had testosterone therapy lost an average of 22.9 kg compared with a weight increase of 3.2 kg in the control group (P < .0001 for all comparisons). Ultimately, in comparison to baseline measures, there was a 24.3% difference in weight loss between the testosterone group (lost 20.3%) compared with the control group (gained 3.9%; P < .0001 for all comparisons) at 10 years.

The testosterone therapy group also experienced an average reduction of 12.5 cm in waist circumference from baseline compared with a 4.6-cm increase in the control group, for a difference of 17.1 cm at 10 years (P < .0001 for all comparisons). The average BMI measure for men in the testosterone group was 7.3 kg/m2 less than at baseline while BMI measures rose by an average of 0.9 kg/m2 for men in the control group, for a difference between groups of 8.2 kg/m2 (P < .0001 for all comparisons). In terms of adverse events, there were more deaths in the control group than in the testosterone therapy group (30.2% vs. 4.4%) at 10 years.

The second study was reported in Diabetes in Control.

A total of 316 men with prediabetes and maximum total testosterone level of 12.1 nmol/L., combined with symptoms of hypogonadism, were pooled from two ongoing urological registries. Parenteral testosterone undecanoate (TU) at the dose of 1,000 mg was administered to 229 individuals every 12 weeks after an initial 6-week interval (T-group). A total of 87 men with hypogonadism who opted against long-term testosterone therapy were considered as an untreated control group. All metabolic and anthropometric parameters, including total testosterone, weight, waist circumference, body weight, hemoglobin, hematocrit, fasting glucose, HbA1c, systolic blood pressure and diastolic blood pressure, heart rate, and lipids, were measured biannually for a total of 8 years.

Data gathered from both T and control groups were averaged each year, then the average yearly data were used to measure differences between the two groups, with adjustment for possible confounders such as age, weight, waist circumference, and BMI. By using a mixed-effects model the average changes over time were compared between both groups.

Results of data analysis showed a significant improvement in glycemic control in T-group. A significant reduction was noted in both fasting blood glucose and HbA1c values in the T-group when compared to the untreated group. On the 8-year follow up, T-group experienced approximately 0.39% reduction in their HbA1c level (P, 0.0001). In contrast, a rise of ~ 0.63% in HbA1c level was noted in the untreated group (P, 0.0001). furthermore, a significant difference in both blood glucose and HbA1c levels was observed between the two groups during the entire 8 years follow up time. All the participants who received long-term testosterone therapy had an average HbA1c of 6.5%, with 90% of them achieving normal HbA1c of 5.7%. A total of 35 (40.2%) patients in the untreated group developed type 2 diabetes (HbA1c of 6.5%) and HbA1c of 5.7% was only seen in one patient among this group.

Long-term testosterone therapy appeared to be associated with significant improvements in fasting glucose, total cholesterol, LDL, HDL, non-HDL, triglycerides, and Aging Males’ Symptoms (AMS) scale. Lastly, the rate of mortality was 7.4% with T-group in contrast to 16.1% in the untreated group (P < 0.05). The prevalence of mild myocardial infarction was 0.4% in the T-group and 5.7% in the untreated group (P < 0.005).