SINGAPORE: In addition to affecting a man’s appearance and sex drive, testosterone can be a factor in the treatment of metabolic disorders such as type 2 diabetes.
If a man is testosterone deficient, increasing male hormone levels could increase insulin sensitivity, which in turn could improve his sugar levels, according to urologist Dr. Joe Lee.
“Adequate testosterone levels can help improve insulin sensitivity and achieve better sugar control. At the same time, it makes it easier for the patient to start exercising and successfully manage weight with less fatigue,” he said.
Fatigue, or a tendency to feel tired all the time, is one of the symptoms of testosterone deficiency, which is defined by persistently low levels of hormones. Other symptoms include sexual dysfunction, poor memory and concentration, and mood swings.
Men who show such symptoms while living with diabetes should have their testosterone levels checked, said Dr. Lee. Twelve is a normal value for total testosterone, he added.
Dr. Lee, director of andrology and male reproductive medicine at the National University Hospital, said between 15 and 25 percent of men with diabetes may have low testosterone levels based on published data.
“I recommend doctors treating diabetes patients check testosterone levels in patients who have significant symptoms of testosterone deficiency such as fatigue, weakness and decreased sexual function,” said Dr. Lee.
Another group of patients who should be screened are those who face a “major challenge” in managing their diabetes despite dietary restrictions and medication, he added.
Dr. However, Lee emphasized, “We do not recommend checking the testosterone levels of every diabetic to avoid over-testing men who do not have a testosterone problem.”
TREATMENT FOR TESTOSTERONE Deficiency
When low testosterone levels are detected for the first time, patients are advised to make some lifestyle adjustments, such as: B. to be more active and eat healthily.
“If a change in lifestyle does not show improvement in testosterone levels or symptoms, then testosterone replacement therapy may be considered,” said Dr. Lee.
Testosterone replacement is usually done every three months with testosterone injections, testosterone gel or testosterone tablets.
Dr. Lee emphasized that testosterone therapy was not the main treatment for diabetes, but rather an “add-on treatment”.
“The patients who benefit must be patients who proactively manage their lifestyle and risk factors. It can’t just be left to testosterone. It’s not a miracle drug, ”he said.
Dr. Vivien Lim, an endocrinologist who runs a clinic at Gleneagles Medical Center on her behalf, said weight problems are strongly linked to central testosterone suppression. At the same time, diabetes itself can affect the nerves and cause erectile dysfunction.
“It is therefore not surprising that many patients with diabetes experience sexual dysfunction and symptoms that are due to low testosterone levels,” she said.
“Unfortunately, this is sometimes ignored and not checked. This aspect should also be given due consideration as part of the overall management of diabetes.”
Dr. However, Lim said the diabetes “can and should still be adequately controlled” whether or not the patient has low testosterone levels.
“We have so many diabetes medicines now and more are coming out as we speak,” said Dr. Lim, who is also President of the ASEAN Federation of Endocrine Societies.
BENEFITS OF TESTOSTERONE THERAPY
Dr. Ronny Tan, consultant urologist and andrologist with Advanced Urology Associates at Farrer Park Hospital, said up to 30 percent of the men who see him for testosterone deficiency would also be diabetic.
“When testosterone levels reach normal levels after treatment, these men are symptomatically better, and when I check the HbA1c of some of these patients, they show improvement,” he said, referring to the measurement of how good the blood sugar was in the three Months before the blood test.
One patient who has benefited from testosterone treatment is official Muthu Karuppiah, who was diagnosed with high cholesterol, diabetes, and high blood pressure about 20 years ago.
While he was able to keep his cholesterol and blood pressure at reasonable levels with medication, diabetes did not.
He would start on some type of medication that would help keep his sugar levels under control for some time, but although his efforts to exercise and control his diet didn’t change, his hbA1c levels would rise again.
“It was depressing and demoralizing, and of course I get a lot of lecture from the professor (his doctor),” said Mr. Muthu.
He received more types of medication and increased doses. However, its effects continued to be temporary and he had to start injecting insulin.
Mr. Muthu was generally conscientious about his weekly walks until three years ago he could not bring himself to carry on. He also felt too tired.
“I know I have to train, but the drive wasn’t there, the motivation wasn’t there. I always hesitate, you know, and say, “Okay, I’ll do it tomorrow, tomorrow, and tomorrow never came,” he said.
Mr. Muthu visited Dr. By the way, Lee last February because of weak bladder problems. Given his symptoms, Dr. Lee ran a testosterone test for his patient that showed he had a low testosterone level of 6, which was below the normal level of 12.
When given the choice of starting testosterone replacement therapy, Mr. Muthu opted for regular testosterone injections. The difference in his energy level was “almost immediately” after his first shock, he said.
“I started exercising and then continued the next day without getting tired,” he said.
Except for a knee operation, which held him back for a while, Mr. Muthu ran 12 km five times a week.
According to this doctor, his hbA1c levels are now reasonably good. And the difference in his behavior has not gone unnoticed.
“Friends I meet after a while say,” I see a lot of change in you, you look livelier, “he said.
Dr. Lee advised men with diabetes who experience symptoms of low testosterone levels to request a checkup to see if their testosterone levels are actually low. The condition is not easy to see, he said. During a typical consultation with a diabetes doctor, symptoms of testosterone deficiency would “by the way” be considered, he added.
To identify testosterone deficient patients, Dr. Lee suggests that it will be good if both doctors and patients play an active role in discussing it.
“If you don’t bring it up and the doctor doesn’t ask, it (testosterone deficiency) may be overlooked,” he said.