Abstract
Background: The current estimated numbers of patients with Type 2 Diabetes (T2D) is believed to be close to 10% of the whole populations of many geographical regions, causing serious concerns over the resulting elevated morbidity and mortality as well as the impact on health care systems around the world. In addition to negatively affecting the quality of life, diabetes is associated with cardiovascular and cerebrovascular complications, indicating that appropriate drug therapy should not only deal with metabolic dysfunction but also protect the vascular system, kidney function and skeletal muscle mass from the effects of the epigenetic changes induced by hyperglycaemia.
Objective: To provide an insight into the management of hypogonadism associated with T2D, this review focuses on clinical observations related to androgen therapy in qualified diabetic patients, and discusses the lines of evidence for its benefits and risks. The potential interactions of testosterone with medicines used by patients with T2D will also be discussed.
Conclusion: From recent clinical findings, it became evident that a considerable percentage of patients suffering from T2D manifested low serum testosterone and experienced diminished sexual activity, as well as reduced skeletal muscle mass and lower bone density. Although there are some controversies, Testosterone Replacement Therapy (TRT) for this particular population of patients appears to be beneficial overall only if it is implemented carefully and monitored regularly.
Keywords: Type 2 diabetes, insulin resistance, hypogonadism, testosterone replacement therapy, drug-drug interactions, vascular system.
[http://dx.doi.org/10.1016/j.diabres.2018.01.005] [PMID: 29405943]
[http://dx.doi.org/10.1136/pmj.2005.039032] [PMID: 16597817]
[http://dx.doi.org/10.1080/00325481.2016.1214059] [PMID: 27458683]
[http://dx.doi.org/10.1056/NEJM199309303291401] [PMID: 8366922]
[http://dx.doi.org/10.1111/cen.12842] [PMID: 26120052]
[http://dx.doi.org/10.1530/EJE-13-0557] [PMID: 24194532]
[http://dx.doi.org/10.1111/j.1464-5491.1988.tb01025.x] [PMID: 2970917]
[http://dx.doi.org/10.1007/BF00400195] [PMID: 1778353]
[http://dx.doi.org/10.1177/2040622314546125] [PMID: 25364492]
[http://dx.doi.org/10.1507/endocrj.EJ12-0117] [PMID: 22572549]
[http://dx.doi.org/10.1111/j.1365-2265.2011.04196.x] [PMID: 21854402]
[http://dx.doi.org/10.1111/j.1743-6109.2007.00531.x] [PMID: 17627750]
[http://dx.doi.org/10.1155/2013/397814] [PMID: 23607045]
[http://dx.doi.org/10.1016/j.diabres.2015.01.037] [PMID: 25747572]
[http://dx.doi.org/10.1530/EJE-15-0359] [PMID: 26101371]
[http://dx.doi.org/10.4103/2230-8229.122006] [PMID: 24672276]
[http://dx.doi.org/10.2337/dc16-2042] [PMID: 27999003]
[http://dx.doi.org/10.2337/diacare.26.5.1553] [PMID: 12716821]
[http://dx.doi.org/10.2337/diaspect.17.4.225]
[http://dx.doi.org/10.1210/jc.2004-0804] [PMID: 15531498]
[http://dx.doi.org/10.1136/bmj.317.7160.703] [PMID: 9732337]
[http://dx.doi.org/10.1016/j.jsxm.2017.07.004] [PMID: 28781213]
[http://dx.doi.org/10.3810/pgm.2008.09.1914] [PMID: 18824832]
[http://dx.doi.org/10.4414/smw.2012.13539] [PMID: 22430839]
[http://dx.doi.org/10.14797/mdcj-13-2-68] [PMID: 28740585]
[http://dx.doi.org/10.1002/phar.1623] [PMID: 26289308]
[http://dx.doi.org/10.2337/diacare.23.4.490] [PMID: 10857940]
[http://dx.doi.org/10.1016/j.clinbiochem.2014.04.004] [PMID: 24768826]
[http://dx.doi.org/10.4103/2230-8210.196008] [PMID: 28217500]
[http://dx.doi.org/10.2337/dc06-1426] [PMID: 17392552]
[http://dx.doi.org/10.2164/jandrol.108.005751] [PMID: 18772488]
[http://dx.doi.org/10.1016/j.freeradbiomed.2017.03.029] [PMID: 28359952]
[http://dx.doi.org/10.1111/andr.12360] [PMID: 28470687]
[http://dx.doi.org/10.1507/endocrj.EJ17-0225] [PMID: 28890481]
[http://dx.doi.org/10.1055/s-0042-121492] [PMID: 28073130]
[http://dx.doi.org/10.1111/jdi.12291] [PMID: 26417412]
[http://dx.doi.org/10.4103/2230-8210.195999] [PMID: 28217495]
[http://dx.doi.org/10.1111/cen.13087] [PMID: 27106511]
[http://dx.doi.org/10.1210/jc.2014-2585] [PMID: 25322269]
[http://dx.doi.org/10.1111/ijcp.12779] [PMID: 26916621]
[http://dx.doi.org/10.3109/13685538.2014.936000] [PMID: 24993355]
[PMID: 24763886]
[http://dx.doi.org/10.1111/jsm.12832] [PMID: 25689116]
[http://dx.doi.org/10.1055/s-0043-102690] [PMID: 28282659]
[http://dx.doi.org/10.1111/jdi.12288] [PMID: 25802717]
[http://dx.doi.org/10.1038/414799a] [PMID: 11742412]
[http://dx.doi.org/10.1172/JCI114644] [PMID: 2189893]
[http://dx.doi.org/10.2174/1381612811319130010] [PMID: 23173591]
[http://dx.doi.org/10.1172/JCI114477] [PMID: 2153712]
[http://dx.doi.org/10.1093/qjmed/94.6.321] [PMID: 11391030]
[http://dx.doi.org/10.1152/ajpheart.00092.2005] [PMID: 15792994]
[http://dx.doi.org/10.1172/JCI117433] [PMID: 8083357]
[http://dx.doi.org/10.1016/j.coph.2013.01.006] [PMID: 23395155]
[http://dx.doi.org/10.1161/01.CIR.0000034509.14906.AE] [PMID: 12379575]
[http://dx.doi.org/10.1097/00075197-200207000-00005] [PMID: 12107372]
[http://dx.doi.org/10.1111/j.1743-6109.2012.02944.x] [PMID: 23035926]
[http://dx.doi.org/10.1111/jsm.12277] [PMID: 23937088]
[http://dx.doi.org/10.1017/CBO9781139003353.019]
[http://dx.doi.org/10.1111/andr.12396] [PMID: 28914503]
[http://dx.doi.org/10.3892/etm.2015.2269] [PMID: 25780423]
[http://dx.doi.org/10.1111/dom.12701] [PMID: 27265844]
[http://dx.doi.org/10.1016/S1569-9056(15)60236-6]
[http://dx.doi.org/10.1111/cen.13130] [PMID: 27292585]
[http://dx.doi.org/10.1177/2042098614548680] [PMID: 25360240]
[http://dx.doi.org/10.1053/meta.2001.24192] [PMID: 11436194]
[http://dx.doi.org/10.1111/j.1464-5491.2005.01448.x] [PMID: 15787679]
[http://dx.doi.org/10.3132/dvdr.2006.023] [PMID: 17160909]
[http://dx.doi.org/10.2337/dc06-1789] [PMID: 17259518]
[http://dx.doi.org/10.4103/1008-682X.122346] [PMID: 24369149]
[http://dx.doi.org/10.1007/s00125-017-4479-9] [PMID: 29046921]
[http://dx.doi.org/10.1152/ajpendo.00373.2007] [PMID: 17711996]
[http://dx.doi.org/10.2337/db13-1909] [PMID: 24651798]
[http://dx.doi.org/10.1186/s40842-018-0061-8] [PMID: 29760945]
[http://dx.doi.org/10.2337/db10-1707] [PMID: 21593202]
[http://dx.doi.org/10.1016/j.bbrc.2010.08.112] [PMID: 20828536]
[http://dx.doi.org/10.3109/00498254.2014.976296] [PMID: 25350082]
[http://dx.doi.org/10.1590/S0004-27302009000800002] [PMID: 20126841]
[http://dx.doi.org/10.1530/JOE-12-0455] [PMID: 23378050]
[http://dx.doi.org/10.1530/EJE-15-1100] [PMID: 26792933]
[PMID: 24943294]
[http://dx.doi.org/10.1055/s-0035-1564073] [PMID: 26372847]
[http://dx.doi.org/10.1016/j.pharep.2015.06.003] [PMID: 26721356]
[http://dx.doi.org/10.1001/jama.2012.227] [PMID: 22396515]
[http://dx.doi.org/10.1016/j.apmr.2008.09.578] [PMID: 19577025]
[PMID: 15719804]
[http://dx.doi.org/10.1152/physrev.00051.2017] [PMID: 29167329]
[http://dx.doi.org/10.1016/S0749-0690(02)00098-8 PMID: 12916285]
[http://dx.doi.org/10.1016/j.maturitas.2015.11.003] [PMID: 26614257]
[PMID: 24994579]
[http://dx.doi.org/10.2478/folmed-2013-0006] [PMID: 23905488]
[http://dx.doi.org/10.1111/jsm.12059] [PMID: 23347341]
[http://dx.doi.org/10.7860/JCDR/2016/19971.8996] [PMID: 28208875]
[http://dx.doi.org/10.1515/hmbci-2016-0014] [PMID: 27071157]
[http://dx.doi.org/10.2337/dc11-0208] [PMID: 21715518]
[http://dx.doi.org/10.1159/000074448] [PMID: 14657608]
[http://dx.doi.org/10.1210/jc.2014-1872] [PMID: 24978674]
[http://dx.doi.org/10.1080/07435800500320653] [PMID: 16353672]
[http://dx.doi.org/10.1530/eje.1.02166] [PMID: 16728551]
[http://dx.doi.org/10.4158/EP09355.OR] [PMID: 20150021]
[http://dx.doi.org/10.1080/13685538.2018.1468429] [PMID: 29708829]
[http://dx.doi.org/10.1186/s40001-014-0056-6] [PMID: 25338765]
[http://dx.doi.org/10.1155/2014/683515] [PMID: 24738000]
[http://dx.doi.org/10.5534/wjmh.180001] [PMID: 29756416]
[http://dx.doi.org/10.1038/nrendo.2013.73] [PMID: 23591366]
[PMID: 29094914]
[http://dx.doi.org/10.1111/ijcp.12200] [PMID: 23714173]
[http://dx.doi.org/10.1016/j.eururo.2017.03.032] [PMID: 28434676]
[http://dx.doi.org/10.1111/ijcp.12235] [PMID: 24355040]
[http://dx.doi.org/10.4103/aja.aja_6_18] [PMID: 29442075]
[http://dx.doi.org/10.1016/S0950-351X(98)80305-4] [PMID: 10332571]
[http://dx.doi.org/10.1002/smrj.43] [PMID: 27784544]
[http://dx.doi.org/10.1016/j.metabol.2014.05.005] [PMID: 24930993]
[http://dx.doi.org/10.1177/1076029613485154] [PMID: 23615294]
[http://dx.doi.org/10.1111/andr.12099] [PMID: 26447645]