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Ronald Swerdloff Part 5, Treating Diabetic Sexual Dysfunction With Testosterone

In part 5 of this Exclusive Interview, Dr. Ronald Swerdloff talks with Diabetes in Control Publisher Steve Freed during the ADA 2017 Scientific Sessions in San Diego, CA about the possibility of testosterone therapy for the person with diabetic sexual dysfunction.

Ronald Swerdloff, MD is a professor of medicine at David Geffen School of Medicine at UCLA, the chief of division of endocrinology and metabolism at the Harbor UCLA Medical Center, and the senior investigator at the LA Biomedical Research Institute.

Transcript of this video segment:

Steve: So if a person with diabetes, blood sugars elevated, we start to see sexual dysfunction.  Would that person be a candidate for testosterone therapy?

Dr. Swerdloff:  Yes I think so. I think that we would then say that this person would be treated for their symptoms of low testosterone. And that those symptoms should improve on treatment. There may be a benefit to blood sugar control, but we don’t know for sure. And there may be risks and today one of our speakers is going to talk about the issues of possible risks to cardiovascular disease, and you already talked to me about possible risk to prostate. Those things are still, as I said, under study. We hope that the risks will be small or nonexistent, but of course we always balance. Any time we treat somebody, we try to balance the benefits and the risks and look for the proper proportion of the two.

Steve:  Let’s say someone with testosterone level of 450 has sexual dysfunction due to their diabetes, would there be a benefit of treating him with testosterone?

Dr. Swerdloff:  I don’t think so. I think if the testosterone level is within the reference range, value of 450 is pretty good value, I don’t think you would treat that person nor do any of the guidelines recommend to treat that person with testosterone. They may have erectile dysfunction, which is common in diabetes, but that may be entirely independent of the testosterone levels, and have to do with diabetes effect on vasculature, or nerve supply of the penis.

Steve:  At what level of A1c do we usually see sexual dysfunction, and can it be reversed?  If the person has an A1c of 8, 9, 10, or 11 and reduces it closer to normal ranges, have we seen the nerves in the sexual dysfunction dissipate?

Dr. Swerdloff:  We wish that were true. Unfortunately, in many instances, once the problem occurs it may be more difficult to reverse. Although like the peripheral neuropathy that people have in diabetes, and some of the other complications, our thesis is that regulation of blood sugar should have a positive metabolic effect and should be beneficial to the patient. It is a lot easier to understand prevention of these problems than it is correction when they are well established.  But, we hope that it would be true.

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