Effect of Testosterone on Progression From Prediabetes to Diabetes in Men With Hypogonadism

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madman

Super Moderator


Abstract

Importance


The effect of testosterone replacement therapy (TRT) in men with hypogonadism on the risk of progression from prediabetes to diabetes or of inducing glycemic remission in those with diabetes is unknown.


Objective

To evaluate the efficacy of TRT in preventing progression from prediabetes to diabetes in men with hypogonadism who had prediabetes and in inducing glycemic remission in those with diabetes.


Design, Setting, and Participants

This nested substudy, an intention-to-treat analysis, within a placebo-controlled randomized clinical trial (Testosterone Replacement Therapy for Assessment of Long-Term Vascular Events and Efficacy Response in Hypogonadal Men [TRAVERSE]) was conducted at 316 trial sites in the US. Participants included men aged 45 to 80 years with hypogonadism and prediabetes or diabetes who were enrolled in TRAVERSE between May 23, 2018, and February 1, 2022.


Intervention

Participants were randomized 1:1 to receive 1.62% testosterone gel or placebo gel until study completion.


Main Outcomes and Measures

The primary endpoint was the risk of progression from prediabetes to diabetes, analyzed using repeated-measures log-binomial regression. The secondary endpoint was the risk of glycemic remission (hemoglobin A1c level <6.5% [to convert to proportion of total hemoglobin, multiply by 0.01] or 2 fasting glucose measurements <126 mg/dL [to convert to mmol/L, multiply by 0.0555] without diabetes medication) in men who had diabetes.


Results

Of 5204 randomized participants, 1175 with prediabetes (mean [SD] age, 63.8 [8.1] years) and 3880 with diabetes (mean [SD] age, 63.2 [7.8] years) were included in this study. Mean (SD) hemoglobin A1c level in men with prediabetes was 5.8% (0.4%). Risk of progression to diabetes did not differ significantly between testosterone and placebo groups: 4 of 598 (0.7%) vs 8 of 562 (1.4%) at 6 months, 45 of 575 (7.8%) vs 57 of 533 (10.7%) at 12 months, 50 of 494 (10.1%) vs 67 of 460 (14.6%) at 24 months, 46 of 359 (12.8%) vs 52 of 330 (15.8%) at 36 months, and 22 of 164 (13.4%) vs 19 of 121 (15.7%) at 48 months (omnibus test P = .49). The proportions of participants with diabetes who experienced glycemic remission and the changes in glucose and hemoglobin A1c levels were similar in testosterone- and placebo-treated men with prediabetes or diabetes.


Conclusions and Relevance

In men with hypogonadism and prediabetes, the incidence of progression from prediabetes to diabetes did not differ significantly between testosterone- and placebo-treated men. Testosterone replacement therapy did not improve glycemic control in men with hypogonadism and prediabetes or diabetes. These findings suggest that TRT alone should not be used as a therapeutic intervention to prevent or treat diabetes in men with hypogonadism.
 
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madman

Super Moderator
Key Points

Question


Does testosterone replacement therapy (TRT) prevent progression from prediabetes to diabetes or induce glycemic remission in middle-aged and older men with hypogonadism?


Findings

In this randomized clinical trial of 5204 participants aged 45 to 80 years with hypogonadism and prediabetes (n = 1175) or diabetes (n = 3880), the risk of progression from prediabetes to diabetes did not differ significantly between a group that received TRT and a placebo group and TRT did not improve glycemic control in men with prediabetes or diabetes.


Meaning

This study did not provide evidence of TRT’s efficacy in preventing progression from prediabetes to diabetes or improving glycemic control in men with hypogonadism.
 

Golfboy307

Active Member
I can't be completely sure of course, but nothing else really changed in terms of diet and exercise.

That is why this study result was somewhat surprising to me. Even my doctor subscribes to the theory that a well-managed TRT program can improve your insulin/sugar markers based on several of his patients.
 

Systemlord

Member
Interesting... it sure helped my A1C.

IMG_0274.png

IMG_0398.png
 

t_spacemonkey

Well-Known Member
they should have added a fasting insulin test, which is a better marker of metabolic health. there is people with normal a1c but super high insulin levels which essentially is 'prediabetes'
 

sammmy

Well-Known Member
There is a clear theoretical reason for TRT to decrease metabolic and diabetes risk: it shoves the blood sugar into muscles more efficiently.

In the "study", there is a clear effect at 6 months and the TRT group always had lower incidence of diabetes but the difference with placebo decreased at 48 months.

I wonder if they bothered to actually measure testosterone and free testosterone levels of the participants, first to make sure the TRT (with Androgel 1.62%) was really effective at increasing the T levels, and second to make sure the ones on placebo gel did not secretly apply real Androgel.

If I was a participant in that study, it is very easy to get a T test and see if I am in the TRT or the placebo group. If I turn out in the placebo group, it is easy to get actual testosterone gel. If there were many people doing that, and they didn't check their T levels, the whole study is invalid.
 

Systemlord

Member
Nice, I'd be interested to see what your are. I got mine yesterday - Im at 73mg/dl the lowest it's been since starting trt in 2015

TRIGLYCERIDE​

View trends
Normal value: <=149 mg/dL
Value
88

HDL​

View trends
Normal value: >=40 mg/dL
Value
38

LDL CALCULATED​

View trends
Normal value: <=99 mg/dL
Value
239

CHOLESTEROL/HIGH DENSITY LIPOPROTEIN​

View trends
Normal value: <=3.9
Value
7.7

CHOLESTEROL​

View trends
Normal value: <=199 mg/dL
Value
292


Ferritin is 222, My hematocrit is 58.5% (wow) and hemoglobin is 18.9.

I feel amazing!!

I guess that explains my very high stamina and energy levels!
 
Last edited:

Fernando Almaguer

Well-Known Member

TRIGLYCERIDE​

View trends
Normal value: <=149 mg/dL
Value
88

HDL​

View trends
Normal value: >=40 mg/dL
Value
38

LDL CALCULATED​

View trends
Normal value: <=99 mg/dL
Value
239

CHOLESTEROL/HIGH DENSITY LIPOPROTEIN​

View trends
Normal value: <=3.9
Value
7.7

CHOLESTEROL​

View trends
Normal value: <=199 mg/dL
Value
292


Ferritin is 222, My hematocrit is 58.5% (wow) and hemoglobin is 18.9.

I feel amazing!!

I guess that explains my very high stamina and energy levels!
Hell yeah!
 

Systemlord

Member
SL - good Tri levels! Will you do anything to try and bring the hematocrit down?
Already did, as explained reducing iron dose causes dehydration. I just restarted my normal iron dose.

My ferritin went up from previously, 198->222, after reducing my iron dose, but the bad side effects of too much iron are all but gone, which is really weird.

It seems like Cialis and iron have some sort of relationship to each other.
 
Last edited:
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