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Does Diabetes Cause Low Testosterone?


ben bunting BA(Hons) PgCert Sport & Exercise Nutriton  Written by Ben Bunting: BA(Hons), PGCert. Sport & Exercise Nutrition. L2 Strength & Conditioning Coach.

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Those with diabetes may wish to understand its relationship to testosterone. This article will cover the following points:

  • What's diabetes?
  • What's testosterone?
  • The link between testosterone and diabetes
  • What happens if you have low testosterone?
  • How to manage diabetes and low testosterone
  • Fix diabetes
  • Conclusion

What is Diabetes?

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Diabetes is a chronic, metabolic disease characterized by persistently high blood glucose (sugar) levels.

Over time, especially if not treated diabetes can cause serious problems and damage your cardiovascular, nervous, and metabolic systems. According to WHO nearly 422 million people in the world have diabetes and about 1.5 million people die annually due to diabetes. [1]

Diabetes can be classified into 3 main types. The two more prevalent types are Type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM). The third type is called gestational diabetes that sometimes occurs in pregnant females.

In type 1 diabetes, your pancreas (the insulin-producing organ) produces little to no insulin whereas in type 2 diabetes your pancreas produces normal to increased amounts of insulin, however, your body tissues become insensitive to it. 

You might be thinking what is this insulin? Insulin is a very important hormone (chemical messenger) that mainly regulates the blood sugar level.

Insulin gets released in response to carbohydrate ingestion, which could be your pre-workout rice, bananas, or some sweets on your cheat day.

It makes different parts of your body, especially muscles and fats, take up glucose. It also helps you grow normally e.g., help grow muscles and other tissues. 

Disturbances in either insulin production or its function could lead to high blood glucose, eventually diabetes.

In case you want to know, what amount of sugar is considered high, the answer is if you’re fasting for 10 hours and your blood glucose level is above 126 mg/dL, you are diabetic. 

What is Testosterone?

Testosterone is one of the androgenic (enhancing male-like features) hormones produced by our bodies.

Despite the common misconception, testosterone is synthesized in both males and females, however, it plays a major physiological role in males. Testosterone, which you might know as the muscle hormone, has quite some functions.

The primary function of testosterone is the growth of sexual organs (libido), but it also promotes bone mass, fat distribution, increases muscle strength and muscle mass, and promotes the production of red blood cells and sperm.

As the genius in you might have spotted, testosterone is the reason why males have more muscle mass and red blood cells. 

For people in the fitness industry, testosterone is a crucial hormone. You might have searched google for ways to improve your testosterone levels in order to enhance your muscle strength and your overall looks.

If you have low testosterone levels (hypogonadism), you are going to find it way harder to grow and maintain muscle mass relative to people with healthy testosterone levels. [2]

Unfortunately, there are many ways you could have low testosterone, and one of them is having diabetes or having too much blood glucose.

What’s the link between testosterone and diabetes?

There are many studies and research that have shown evidence that diabetes causes low testosterone levels in males. [3] This side-effect is more pronounced in individuals with T2DM than T1DM but can occur in both.

Both high levels of insulin (T2DM) and high blood glucose (in T1DM and T2DM) can lead to this unfortunate outcome. 

Let’s look at hyperglycemia first, a fancy way to say high blood glucose. Having an elevated level of glucose affects almost all organs, but the most pronounced effect is on the blood vessels and nerves of your body.

Elevated glucose levels in the body make your blood vessels plastic, i.e., they lose their elasticity decreasing the lumen diameter. This reduction in diameter leads to hypoperfusion (low blood flow) of several organs in your body.

Some pronounced effects of this vessel damage are strokes, kidney diseases, erectile dysfunction, and testicular problems including low testosterone, and/or vision loss. 

There are different theories about how high blood sugar levels can affect the production of testosterone. Some researchers have hinted that pituitary-gonadal excess gets disturbed by high glucose levels.

The pituitary gland normally secretes luteinizing hormone (LH) which helps an adequate production of testosterone in males. High sugar might be associated with the decreased or irregular release of LH which eventually decreases testosterone production in patients with diabetes. However, there is room for more research on this effect.  

Secondly, the increased levels of insulin itself (in T2DM) are highly associated with decreased production of testosterone.

There are several theories that suggest this relationship. As you already read above, high glucose and insulin levels make our body cells insensitive. Consequently, there is a decreased uptake of glucose in many body cells including testicular cells and even the areas of the brain (hypothalamus and pituitary) that help synthesize LH.

Low glucose levels in these tissues acutely causes a decrease in LH and testosterone synthesis. [4] Interestingly, due to low LH, our hypothalamus stimulates the pituitary gland which in turn causes an increased production of another hormone called dehydroepiandrosterone (DHEA). This hormone is believed to further decrease testosterone production in your testes. 

Another interesting research carried out on a population of male mice has revealed interesting facts about the insulin-testosterone relationship in TD2M patients. The rats with T2DM had significantly low testicular mass and testosterone production.

This effect was brought about by decreased production of vascular endothelial growth factor (VEGF), which is normally released by vessels and other tissues. It supports the growth and sustainability of blood vessels. [5]

Unfortunately, high insulin and glucose levels tend to decrease VEGF, which in turn causes vascular destruction of the testes leading to hypo-perfusion of the testes. 

This has been shown to decrease testicular mass and eventual decline in testosterone. The study also suggested that reproductive organs (testes) are also sensitive to increased glucose levels in the blood. 

So?

You might be thinking, what is the point of all this conversation? It is simple. There is proper evidence that diabetes can cause low testosterone in males. Surely, it is more pronounced in people with long-standing type 2 diabetes, but can occur in both type 1 and type 2 diabetes mellitus. [6]

What happens if you have low testosterone?

A testosterone level lower than normal is certainly a cause of concern, especially for the male population. You can experience a range of symptoms and effects due to low testosterone. To name a few:

  • Low sex drive- one of the biggest concerns regarding low testosterone is decreased sexual drive and libido. It can occur in both males and females; however, it is more pronounced in males leading to erectile dysfunction, decreased sexual stamina, etc. [7]
  • Decreased strength and muscle mass- for our fitness freaks, this might be the worst news. Low testosterone can significantly decrease your athletic performance. As mentioned above, testosterone is essential for muscle growth, strength, and physical stamina. Low testosterone means that you are going to feel weak in your workouts, your muscle is going to waste despite a good diet and workout routine, and you might not see the good results you want to see. 
  • Increased fat and obesity- one interesting thing that testosterone does is to mobilize and use fats while increasing muscle growth. This is one of the reasons your trainers push to strength training. Increased exercise, increase muscle, and decreased fat over your body. And frankly, who wouldn’t want a lean body. 
  • Reduced bone mass and anemia- testosterone is also somewhat responsible for the production of red blood cells and maintaining bone mass. A chronic (long-term) decrease in the levels of testosterone could result in fatigue, bone pain, and even fractures. 
  • Depressed mood.
  • Difficulty in concentration and memory.
  • Irritability and mood swings.
  • Decreased sense of well-being.

Just as a side note, these effects can occur in females with diabetes too. 

How to manage diabetes and low testosterone

It seems like there is enough discussion about how diabetes causes low testosterone and reduced masculinity.

Let’s discuss how you and people around you can help themselves and correct this deleterious effect of diabetes. 

Fix Diabetes

As for most of the conditions of our body, the underlying cause is the primary treatment. You might have guessed this one - treating diabetes. Whether you have type 1 diabetes, type 2 diabetes, or gestation diabetes, you have to control this condition. 

There are several ways you can control your diabetes. These include:

Dietary modifications

This is probably the most important determinant of your diabetes-testosterone axis. Most people end up having diabetes due to poor dietary choices.

You simply have to give up triggering foods like excessive sweet intake, high-fat diet, irregular eating, excessive drinking (alcohol, or other sweetened beverages), etc.

On the other hand, you have to eat whole foods, like lean protein (fish, chicken), your very important greens (fruits and vegetables), nuts, legumes, and fresh, natural juices (beverages). 

These whole foods are not only gonna control your flying high glucose and insulin, but they will also increase your testosterone levels. For instance, bananas and whole nuts are great foods to increase your testosterone.

We know that saying it is way simpler than doing it. However, it is not impossible. Like many of us have done it, you can nail it too!

Take help from people around you, or some professional and take small steps towards your goal. You’ll get there, for sure!

Exercise

Exercise is also a very crucial lifestyle modification for controlling diabetes and saving yourself from low testosterone. [8]

Exercising has multiple benefits for diabetic patients. Studies have shown that exercising 3-4 times a week for over 30 minutes, helps you lose weight, gain muscle mass, and increase your testosterone levels.

This exercise could be in the form of strength training, weightlifting, running, cycling, or even a trek around your nearest hill. 

Biochemically, exercise makes your body cells more sensitive to insulin. Thus they start functioning better and reduce your body's glucose and insulin level and all those chains of events causing your low testosterone.

Eventually, your blood sugar is controlled and your testosterone is thriving making you look fit and feel strong. 

Having a good routine

This fact is often not taken into consideration, but it does carry a lot of weight when it comes to a healthy body and mind.

A good routine refers to a balanced day, that includes waking up early, eating good foods, meditating, doing your chores, and, of course, sleeping.

A good 7 - 8 hours of night sleep favors positivity in your body, including higher levels of testosterone. Sleeping too less, or too much, or sleeping at awfully awkward times, however, does not help and can reduce testosterone levels. [9]

Reduce alcohol intake

you might be thinking that I have already stated alcohol in the diet section, and you are right. But, drinking alcohol deserves more attention.

Alcohol is highly associated with a lot of metabolic disorders, if not all, including diabetes. [10]

If you are a heavy drinker, you might want to consider lowering down the amount of alcohol you drink.

Binge drinking, which is defined as 5 alcohol drinks for men and 4 alcohol drinks for women, within 2 hours, is highly associated with insulin resistance, and high blood sugar levels. You know what follows, diabetes, and low testosterone. 

Medication 

You can supplement your diabetic control with medications. These can include, metformin, statins, and insulin, etc.

However, a timely diagnosis is suitable. Visit your doctor or physician to get help with your diabetes. 

    Conclusion

    Despite all the concerns, diabetes is controllable and there are many people living a healthy life with diabetes.

    Yes, it leads you to serious problems, decreases your testosterone and many other good nutrients of your body, however, you can stop it. Make up your mind today and start with small goals.

    Improve your daily routine, be mobile, and eat well, and stay fit. You can definitely increase your testosterone levels with such simple steps, motivation, and dedication. Do not worry if you miss a day or two, just make sure you have the goal in your sight every day.  

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    References:

    1. World Health Organization (2021). Diabetes. [online] Who.int. Available at: https://www.who.int/news-room/fact-sheets/detail/diabetes.

    2. Kumar, P., Kumar, N., Thakur, D. and Patidar, A. (2010). Male hypogonadism: Symptoms and treatment. Journal of Advanced Pharmaceutical Technology & Research, [online] 1(3), p.297. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3255409/.

    3. Kerstin M. Oltmanns, Bernd Fruehwald-Schultes, Werner Kern, Jan Born, Horst L. Fehm, Achim Peters, Hypoglycemia, But Not Insulin, Acutely Decreases LH and T Secretion in Men, The Journal of Clinical Endocrinology & Metabolism, Volume 86, Issue 10, 1 October 2001, Pages 4913–4919, https://doi.org/10.1210/jcem.86.10.7892
    4. Handelsman DJ, Conway AJ, Boylan LM, Yue DK, Turtle JR. Testicular function and glycemic control in diabetic men. A controlled study. Andrologia. 1985;17(5):488-496. Available at: https://onlinelibrary.wiley.com/doi/10.1111/j.1439-0272.1985.tb01047.x

    5. Long, L., Qiu, H., Cai, B., Chen, N., Lu, X., Zheng, S., Ye, X. and Li, Y. (2018). Hyperglycemia induced testicular damage in type 2 diabetes mellitus rats exhibiting microcirculation impairments associated with vascular endothelial growth factor decreased via PI3K/Akt pathway. Oncotarget, [online] 9(4), pp.5321–5336. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5797052.‌

    6. Grossmann, M. (2011). Low Testosterone in Men with Type 2 Diabetes: Significance and Treatment. The Journal of Clinical Endocrinology & Metabolism, 96(8), pp.2341–2353. Available at:  https://pubmed.ncbi.nlm.nih.gov/21646372/
    7. Al-Kuraishy, H.M. and Al-Gareeb, A.I. (2016). Erectile Dysfunction and Low Sex Drive in Men with Type 2 DM: The Potential Role of Diabetic Pharmacotherapy. Journal of Clinical and Diagnostic Research : JCDR, [online] 10(12), pp.FC21–FC26. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5296448/.‌

    8. Mathis Grossmann, Merlin C. Thomas, Sianna Panagiotopoulos, Ken Sharpe, Richard J. MacIsaac, Sophie Clarke, Jeffrey D. Zajac, George Jerums, Low Testosterone Levels Are Common and Associated with Insulin Resistance in Men with Diabetes, The Journal of Clinical Endocrinology & Metabolism, Volume 93, Issue 5, 1 May 2008, Pages 1834–1840, https://doi.org/10.1210/jc.2007-2177
    9. Wittert, G. (2014). The relationship between sleep disorders and testosterone in men. Asian Journal of Andrology, [online] 16(2), p.262. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3955336/.‌

    10. Emanuele, N.V., Swade, T.F. and Emanuele, M.A. (1998). Consequences of alcohol use in diabetics. Alcohol health and research world, [online] 22(3), pp.211–9. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6761899/.