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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 insulin resistance?
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 proof, researchers put low T men on Hormone Replacement Therapy and watched their insulin levels fall.. 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 Japanese-American men"
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"
|WHAT LOW T DOES:|