Testosterone and Diabetes
What if I told you that I knew of a cure for adult onset diabetes (in men)? Or what
if I told you that there was a simple injection that would completely reverse
the diabetes of many middle-aged and senior patients? Well, it's true and
very few doctors know about it.
How did I find out about it? Well, I was told by one (pretty large) HRT
clinic that every one of their type II diabetic patients was able
to completely get off of insulin. Now a couple of them still had to take
Metformin, but still it is incredible that all of these men were able to
completely get off of insulin. This should be front page medical press
news, but, unfortunately, no one is interested.
Now has does this HRT clinic do it? They simply take their men to fairly
high testosterone levels - about an average of 1000 ng/dl via weekly
injections and then make sure that estradiol is managed biweekly doses of
Arimidex (if needed). So the typical man in this clinic is hypogonadal
with testosterone less than 400 ng/dl and then gets boosted to the level of a 20
year old. Here is the key: in general, as testosterone rises,
insulin levels fall. And, as insulin levels fall, insulin resistance is
decreased and blood sugar levels fall. This is why increasing testosterone
so significantly completely eliminates their need for insulin.
CAUTION: Can all low testosterone men be cured of their type II
diabetes through HRT? Probably not. Nor am I
saying that everone should go on HRT. But I
mention the above story, because it is definitely something to discuss with a knowledgeable
physician if you are having insulin-related issues. Even if it halves your need for insulin, that would be an
impressive accomplishment, right? Men with Metabolic Syndrome (prediabetes) should
take not that testosterone therapy has actually been part of a very successful
treatment protocol that completely reversed the condition in the great majority
of men. See this link on
and Metabolic Syndrome for more information.
CAUTION #2: Some men with diabetes have weakened renal function. It turns out that
testosterone can be hard on kidneys, at least in men with existing kidney disease. Discuss with
your doctor if you are diabetic and considering going on HRT.
NOTE: Diabetes is known to accelerate overall aging and it can have a
profound affect on one's sex life. See this link on
Diabetes and Erectile
Dysfunction for more details.
So is the story above supported by the studies? Indirectly, yes,
although studying the effects on diabetics of going to this high of testosterone
levels has not been looked at as far as I know. But look below at the many
ways that testosterone is tied into and can reverse or prevent adult onset diabetes:
1. Hypogonadism and Diabetes Risk. The studies show clearly
that low testosterone increases the risk for diabetes. At what T level
will the risk of diabetes increase significantly? A couple of studies give us
some interesting insights. The first looked at several hundred
community-dwelling seniors and found that men in the lowest quartile of low
testosterone had a dramatically increased risk (2.7 times) of developing
diabetes. The lowest quartile in this case was found to be total testosterone
less than 256 ng/ml (8.6 nmol/l).  Other studies have found similar numbers,
around 294 ng/dl (10 nmol/l) for example. 
2. Insulin and Insulin Resistance. As mentioned above, falling
testosterone levels are correlated with rising insulin and insulin
resistance. Of course, the question is if testosterone is causative. We
know that adding body fat promotes insulin resistance and lowers testosterone.
But can the reverse also be true? Can low testosterone actually increase
The answer to that was clearly shown in some animal studies, where rats were
castrated and the authors found that insulin resistance followed along with a
decreased ability to utilize glucose. Over the years resarchers clearly
concluded that even in humans "low testosterone levels and impaired
mitochondrial function promote insulin resistance in men."  And , as further
put low T men on
Hormone Replacement Therapy and watched their insulin
See my link on
Testosterone and Insulin for more details,
but a perfect example was a study that gave testosterone to hypogonadal men with type II
diabetes. What happened? Every standard diabetes measure improved -
that's what happened! And, yes, both fasting insulin and insulin
sensitivity improved markedly. 
3. Blood Glucose Levels. Now, if testosterone really improves
insulin sensitivity, wouldn't you expect testosterone therapy to generally
result in lower blood glucose levels, at least in low T men? Of course,
this has been verified both in studies and cliically, such as the story I told
above. In fact, the same study mentioned in #2 also
showed substantial reduction in blood glucose levels.  Both glycated
hemoglobin (A1C) and fasting blood glucose levels went down. Glycated hemoglobin,
for the unitiated, is essentially a way to measure a rolling (approximately) 90 day average
of blood glucose levels. It is not a perfect measurement but, in this case, shows
that average glucose levels were substantially reduced through testosterone therapy.
4. Eliminated Risk of Dying. Let's start with a profound study of type II (adult onset) diabetics that grouped men according to testosterone
levels. They found that the hypogonadal men, defined as less than 306
ng/dl (10.4 nmol/l), had double the chance of dying. This is very
large increase in mortality - usually studies are looking 20%, 30%, etc
Yet in this case, a man has
twice the risk of dying with both low testosterone and diabetes.
What was the solution? When the researchers gave the diabetic men
with low T testosterone therapy, the results were impressive: a mortality
rate equal to that of the diabetic men with normal T.  In other words, the researchers
found that if you put them on HRT, it eliminated ALL the additional risk of dying, leaving
them at the same risk on average as other diabetic men. This is good news, because it suggests that
the ravages of low testosterone are largely reversible in men with glycemic issues such as pre-diabetes,
diabetes and possibly Metabolic Syndrome, a large cross section of any modern, industrialized society.
5. Visceral Fat. Belly fat and insulin resistance go hand in hand -
something I disucss in my link on Visceral Fat.
A lot of belly fat on a man (or woman for that matter) is a sure sign that
they have lost or are losing their insulin sensitivity. Testosterone, or the lack thereof,
can definitely play a strong role. A couple of studies have found, for example,
that low testosterone is correlated with higher visceral fat levels. 
One of these studies found that "obesity is associated with low testosterone
levels in diabetic men." Now we know that obesity can actually cause low
testosterone by actually shutting off the signaling from the hypothalamus /
pituitary. So is this all that is going on? Low T correlates with
belly fat simply because obesity causes low T?
It turns out that that is not the whole story as evidenced by the fact that
giving hypogonadal (diabetic) men testosterone lowers belly fat without doing
anything else.  So, if you want to get rid of that belly fat, improving
your testosterone levels will very likely help. Of course, it's not a miracle
cure: diet and exercise are kings.
1) Asian Journal of Andrology, 2010, 12:136–151, "Androgens and male aging:
current evidence of safety and efficacy"
2) Diabetes Care, Jan 2002, 25(1):55-60, "Endogenous Sex Hormones and the Development of Type 2
Diabetes in Older Men and Women: the Rancho Bernardo Study"
3) Eur J Endocrinol, June 1 2006, 154:899-906, "Testosterone replacement therapy
improves insulin resistance, glycaemic control, visceral adiposity and
hypercholesterolaemia in hypogonadal men with type 2 diabetes"
4) International Journal of Obesity and Related Metabolic Disorders : Journal of
the International Association for the Study of Obesity, 2000, 24(4):485-491,
"Low serum testosterone level as a predictor of increased visceral fat in
5) Diabetes Care, Apr 2007, 30(4):911-917, "Clinical and Biochemical Assessment
of Hypogonadism in Men With Type 2 Diabetes Correlations with bioavailable
testosterone and visceral adiposity"
6) Diabetes Care, July 2005, 28(7):1636-1642, "Relationship Between Testosterone
Levels, Insulin Sensitivity, and Mitochondrial Function in Men"
7) The Aging Male, 2003, 6(1):1-7, "Testosterone supplementation in men with type
2 diabetes, visceral obesity and partial androgen deficiency"
8) Acta Physiologica Scandinavica, Dec 1992, 146(4):505–510, "The effects of
testosterone on insulin sensitivity in male rats"