Background: Metabolic syndrome (MetS) and diabetes type 2 (DM2) are increasing in incidence in the United States. A recent study found that roughly 34% of the adult population meets the criteria for metabolic syndrome. Patients with metabolic syndrome were found to have a 3 fold higher incidence of MI, stroke and CHD compared to patients without MetS. They were also more likely to develop DM2. Men with metabolic syndrome or DM2 also have a higher incidence of hypogonadism. It is estimated that 37.8% of men >45 years are hypogonadal. Multiple studies have established a link between hypogonadism and metabolic syndrome and the next step is to evaluate if raising a man’s testosterone levels back to physiologic norms has any benefit in the treatment of metabolic syndrome or DM2.
Methods: A comprehensive review of the literature was performed using the data bases: CINAHL, ovid - Medline, EBMR Multifile, Web of Science, PubMed and Google scholar. This produced a number of studies and the following exclusion criteria were applied to limit the search. Exclusion criteria: studies in another language, studies not using testosterone as a therapy, studies on patients who did not have MetS or DM2, studies on women, studies using non-hypogonadal men, studies with a sample size less than 15.
Results: This resulted in three studies which were evaluated for this review. In all three studies evaluated, there was a greater improvement in patients treated with testosterone therapy than placebo. In the 52 week study of diet and exercise compared to diet and exercise plus testosterone, 62.5% of testosterone patients no longer met the criteria for MetS and 87.5% of them reached a HgbA1c goal of < 6.5%. The two other studies, which only had a treatment phase of 3 months, also had promising results. Both studies demonstrated a drop in fasting glucose and insulin levels which corresponded to a decrease in HgbA1C. Patients in all three studies had improvements in BMI and waist to hip ratio. There were no adverse outcomes reported in any of the studies.
Conclusion: Testosterone replacement therapy appears to be beneficial in more places than the bedroom. We have yet to discover all effects testosterone replacement has on the body, but initial studies are promising. Preliminary studies demonstrate that testosterone replacement in hypogonadal men has a greater benefit than risk. It is currently recommended to test men with symptoms of hypogonadism, especially if they have concurrent MetS or DM2. Returning a man’s T level back to physiologic norms can improve MetS and potentially slow its progression to DM2.
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