In part 2 of this Exclusive Interview, Michael Irwig talks with Diabetes in Control Publisher Steve Freed about symptoms of low testosterone, when to test for testosterone issues and the relationship between diabetes and sexual dysfunction.
Michael Irwig, MD, FACE, is a general endocrinologist at George Washington University in Washington, D.C.
Transcript of this video segment:
Freed: And what are the symptoms of low testosterone? I mean, if a patient comes into your office, he’s a type 2 patient, he’s obese, do you automatically recommend the testosterone levels?
Irwig: So, I would take a careful history like in any case and see what symptoms are bothering this patient. If he’s not having any symptoms, I would definitely not go ahead and test. But the problem is that a lot of the symptoms are nonspecific, which means that they overlap with a million other things. So, a lot of times men have fatigue or they’re not sleeping enough or they have a depressed mood, these are all linked to low testosterone but they’re also linked to a million other things. So, that’s why using the symptoms is tricky. The more specific symptoms are the three sexual symptoms, so having low sexual desire or low libido, morning erections, and then erectile function. But even with these symptoms, these again are often nonspecific because erectile dysfunction often correlates to a man’s age. It goes up as men get older. It also can be a complication of diabetes, due to nerve damage, hypertension, high cholesterol. It could be a side effect of the many medicines that our patients are on.
Freed: So, if you wanted to get a testosterone test for one of your patients, as far as the ICD-9 codes, et cetera, that you’re required to have in order for the insurance to pay for it, what type of things must you put in there — what type of symptoms, so the insurance companies will actually pay for it?
Irwig: Usually erectile dysfunction is a good symptom that will be covered. Fatigue is also covered, I know. Sometimes I’ve had problems in the past with the low libido and sometimes that code was not covered for that particular lab.
Freed: And what is the relationship between diabetes and sexual dysfunction that we hear so much about?
Irwig: As men get older testosterone levels can decline. So, roughly after age 40, testosterone levels go down very slowly as men age. But for men who have chronic conditions such as diabetes, the testosterone level can go down more rapidly than if they didn’t have diabetes, so that’s one possibility. So, testosterone is clearly linked to other medical conditions. So, the more medical conditions somebody has and then the more chronic illnesses, they’re more likely to have lower testosterone levels. And then diabetes can do damage. So, diabetes can cause nerve damage; it’s a very common cause of erectile dysfunction for example.
Freed: If a person lowers their A1C more into the normal ranges, will the testosterone go back up?
Irwig: So, there are very interesting studies looking at testosterone concentrations and insulin resistance. And some of the studies do show a relationship that’s a bidirectional. So, low testosterone can be linked to insulin resistance and vice versa. And we’re always wondering is it the chicken or the egg? Which one is causing which, or are they just associations?