She and her colleagues analyzed data on 1,413 men aged 20 years or older who participated in the Third National Health and Nutrition Examination Survey. Diabetes had been diagnosed in 101 men.

In analyses adjusted for age, race and adiposity, men in the lowest tertile of free testosterone were four times more likely to have prevalent diabetes compared with men in the highest tertile (odds ratio, 4.12).

Similar results were evident for bioavailable testosterone, where the odds ratio for diabetes was 3.93 for men in the lowest tertile relative to men in the highest tertile.

The association with low free testosterone persisted even after men with clinically low total and/or free testosterone levels were excluded, suggesting, the researchers say, that the association is not entirely driven by hypogonadal men.

"Obesity affects testosterone levels; testosterone levels drop in men who are overweight or obese," Dr. Selvin pointed out. Yet, "even after accounting for the effect of obesity, low testosterone levels still appear to be an important risk factor for diabetes," she said.

These data, the researchers write, "support the hypothesis that androgens may directly influence glucose metabolism and the development of insulin resistance, independent of the effects of obesity."

Dr. Selvin added, "An important message for clinicians is that low testosterone is a common finding among men with diabetes and may lead to other clinical problems."
Diabetes Care 2007;30:234-238.

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