Low Testosterone Increases Risk of Atherosclerosis for Men with Diabetes

Men with low testosterone have more than a 40% higher relative risk than men with normal testosterone…

Among men, a low testosterone level in blood often goes undiagnosed because its symptoms are similar to other conditions. Men with diabetes and low testosterone levels are more likely to suffer from diminished sexual desire, erectile dysfunction, reduced lean body mass, depressed mood, and fatigue than men without diabetes. In addition to diabetes, metabolic syndrome, obesity, and high blood pressure have all been linked to testosterone deficiency.

Researchers conducted a cross-sectional study evaluating 115 type 2 male patients 70 years or younger with atherosclerotic disease markers with normal and low plasma level of total testosterone. Patients in the study had no history of cardiovascular events, and with normal [≥3.5 ng/mL (≥12.1 nmol/L), n = 79] or low [< 3.5 ng/mL (≤12.1 nmol/L), n = 36] total testosterone. C-reactive protein, carotid artery intima-media thickness (IMT), and atherosclerotic plaque by high-resolution B-mode ultrasound were measured, and endothelial function was assessed by brachial artery flow-mediated dilation.

Results of the study showed that the normal testosterone level group had higher HDL cholesterol levels (P<0.002). Patients with low testosterone had higher IMT compared with those with normal testosterone (P<0.0001). Compared with the normal free testosterone group, those in the low free testosterone group had higher IMT (P<0.0001). Participants with normal or low free testosterone had similar plaque presence (P<0.65). Participants with positive endothelial function had serum total testosterone levels of 13.52 nmol/L and free testosterone levels of 96.5 pg/mL, whereas participants without endothelial dysfunction had serum total testosterone levels of 18 nmol/L and free testosterone levels of 66.1 pg/mL (P<0.001).

Study showed low levels of testosterone in plasma of middle-aged males are associated with more advanced atherosclerotic disease markers in patients with type 2 DM. Prior studies are done in similar population subtype concluded the association of low testosterone with metabolic processes. Randomized trials are needed to confirm the clinical significance of their findings and to assess the clinical impact of testosterone replacement on cardiovascular risk factors in men with type 2 diabetes and low total testosterone.

Practice Pearls:

• Results of the study suggest health care providers should be more vigilant about heart health in this patient population
• Testosterone level should be acquired in patients with type 2 DM and cardiovascular risk factors

Farias JM, Tinetti M, Kohury M, Umpierrez GE. Low testosterone concentration and atherosclerotic disease markers in male patients with type 2 diabetes. [Epub ahead of print] J Clin Endocrinol Metab. 2014 Oct 16.