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Cited by 117Hormonal and reproductive studiesDiabetes, Cardiovascular Risks, and LipoproteinsMenopause: Health Impacts and Treatments

The impact of testosterone replacement therapy on glycemic control, vascular function, and components of the metabolic syndrome in obese hypogonadal men with type 2 diabetes

Open access
Groti, Kristina, Žuran, Ivan, Antonič, Blaž, Foršnarič, Lidija, Pfeifer, Marija·2018·The Aging Male
DOI 10.1080/13685538.2018.1468429
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Abstract

OBJECTIVE: This study set out to assess effects of testosterone replacement therapy (TRT) on parameters of metabolic syndrome and vascular function in obese hypogonadal males with type 2 diabetes mellitus (DM2). STUDY DESIGN: Fifty-five obese hypogonadal diabetic males on oral hypoglycemic treatment were enrolled into this one-year, double-blind, randomized, placebo-controlled clinical study. Group T (n = 28) was treated with testosterone undecanoate (1000 mg i.m. every 10 weeks) while group P (n = 27) received placebo. METHODS: Anthropometrical and vascular measurements - flow-mediated dilatation (FMD) and intima media thickness (IMT) - biochemical and hormonal blood sample analyses were performed at the start of the study and after one year. Derived parameters (BMI, HOMA-IR, calculated free testosterone (cFT) and bioavailable testosterone (BT)) were calculated. RESULTS: TRT resulted in reduction of HOMA-IR by 4.64 ± 4.25 (p < .001), HbA1c by 0.94 ± 0.88% points (p < .001), and an increase in FMD by 2.40 ± 4.16% points (p = .005). CONCLUSION: TRT normalized serum testosterone levels, improved glycemic control and endothelial function while exerting no ill effects on the study population.

AI snapshot

Written from the paper’s full text.

TL;DR

In obese hypogonadal men with type 2 diabetes, one year of testosterone replacement therapy improved insulin resistance, glycemic control, and endothelial function compared with placebo. The authors conclude TRT normalized testosterone levels and had no observed ill effects in this small trial.

Key findings

  • TRT reduced HOMA-IR by 4.64 ± 4.25 (p < .001), HbA1c by 0.94 ± 0.88 percentage points (p < .001), and fasting plasma glucose by 1.23 ± 1.25 mmol/L (p < .001); placebo HbA1c fell by 0.24 ± 0.39 percentage points (p = .004), with a between-group HbA1c difference of 0.70 percentage points (p < .001).
  • Total testosterone increased from 7.24 ± 1.97 to 17.04 ± 3.07 nmol/L in the TRT group (p < .001), with significant increases in calculated free testosterone and bioavailable testosterone; SHBG did not change significantly.
  • Flow-mediated dilatation improved by 2.40 ± 4.16 percentage points in the TRT group (p = .005) and did not change in placebo; carotid intima-media thickness decreased in both groups, but the TRT decrease was 0.10 ± 0.06 mm versus 0.05 ± 0.09 mm with placebo.
  • No significant changes were seen in LDL-cholesterol, HDL-cholesterol, triglycerides, or blood pressure; total cholesterol decreased in both groups (TRT −0.70 ± 0.57 mmol/L, p < .001; placebo −0.42 ± 0.78 mmol/L, p = .010). Hematocrit rose by 2.14 ± 2.42 percentage points in the TRT group but never exceeded 52%; PSA rose by 0.22 ± 0.39 µg/L (p = .006), and no adverse health effects related to TRT were observed.

Methods

  • One-year, randomized, double-blind, placebo-controlled study of 55 obese men with type 2 diabetes not treated with insulin and confirmed untreated late-onset hypogonadism; group T (n = 28) received testosterone undecanoate 1000 mg intramuscularly every 10 weeks after an initial 6-week interval, and group P (n = 27) received placebo.
  • Baseline and 12-month assessments included anthropometrics, biochemical and hormonal blood tests, HOMA-IR, calculated free and bioavailable testosterone, brachial artery flow-mediated dilatation and nitroglycerine-mediated dilatation, and carotid intima-media thickness; hematocrit and PSA were checked every three months.
  • Analyses used independent and paired t-tests, Pearson correlations, and p < .05 for significance, with SPSS 17.0.

Limitations

  • Stated limitations: Not stated in the paper.
  • Evident limitations: the trial was small (55 men) and single-center, with only one year of follow-up; baseline intima-media thickness differed between groups despite randomization.
  • Evident limitations: patients were not advised to change diet or lifestyle, yet both groups showed significant reductions in BMI, waist circumference, and total cholesterol, suggesting nonspecific study-participation effects; many patients also received lipid-lowering and antihypertensive medications, which may confound metabolic and vascular outcomes.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1080/13685538.2018.1468429

Cites

78 of 78 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 26 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    There was a negative correlation between mean changes in total testosterone and HOMA-IR over the study (r = -0.446, p = .001).

    “the correlation between mean changes of TT and HOMA-IR over the course of this study was also negative (r ¼ À0.446, p ¼ .001).”
    Quote in the paperSubstantial claim
  • Findingown data

    There was a moderately negative correlation between total testosterone levels and HbA1c (r = -0.297, p = .028).

    “Correlation between the levels of TT and HbA1c was moderately negative (r ¼ À0.297, p ¼ .028).”
    Quote in the paperNot a substantial claim
  • Findingown data

    In the placebo group, mean HbA1c decreased by 0.24 percentage points (p = .004).

    “The mean difference in group P, while statistically significant, was mere 0.24% points (p ¼ .004).”
    Quote in the paperNot a substantial claim
  • Findingown data

    In obese hypogonadal men with type 2 diabetes, one year of TRT increased flow-mediated dilatation (FMD) by 2.40 ± 4.16 percentage points (p = .005).

    “an increase in FMD by 2.40 ± 4.16% points (p ¼ .005)”
    • Also stated in: § Vascular studies · plain
      “FMD improved by 2.40 ± 4.16% points (p ¼ .005) in group T after one year of testosterone treatment.”
    Quote in the paperSubstantial claim
  • Findingown data

    In obese hypogonadal men with type 2 diabetes, one year of testosterone replacement therapy reduced HOMA-IR by 4.64 ± 4.25 (p < .001).

    “TRT resulted in reduction of HOMA-IR by 4.64 ± 4.25 (p < .001)”
    • Also stated in: § Effects of TRT on components of the metabolic syndrome and insulin sensitivity · plain
      “The HOMA-IR decreased significantly in group T by 4.64 ± 4.25 (p < .001).”
    Quote in the paperSubstantial claim
  • May combine two claims. 32
  • Classified as probably not a substantial claim. 16
  • The quote only partly states this claim. 1

  • May combine two claims.

    Findingown data

    No statistically significant difference between the two groups or the change of their mean anthropometric parameters could be shown.

    “No statistically significant difference between the two groups or the change of their respective mean anthropometric parameters could be shown.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Both the placebo and TRT groups showed statistically significant reductions in BMI and waist circumference after one year.

    “BMI and WC showed statistically significant reductions in both groups after one year of the study.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    There was a small but statistically significant change in total testosterone level in the placebo group (from 7.96 ± 1.34 nmol/l to 9.83 ± 1.51 nmol/l, p < .001).

    “There was a small but statistically significant change in TT level (from 7.96 ± 1.34 nmol/l to 9.83 ± 1.51 nmol/l, p < .001) in group P as well.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Total testosterone, calculated free testosterone, and calculated bioavailable testosterone concentrations increased significantly in the TRT group.

    “TT, cFT, and calculated BT concentrations increased significantly in group T.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    No statistically significant changes were observed in either systolic or diastolic blood pressure levels following TRT.

    “No statistically significant changes were observed in either systolic or diastolic blood pressure levels following TRT.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Throughout one year, levels of hemoglobin, red blood cell counts, and hematocrit increased, but hematocrit values never exceeded the upper safety limit of 52%.

    “Throughout one year of the study levels of hemoglobin (Hb), red blood cell (RBC) counts and hematocrit (Hct) increased, but Hct values never exceeded the upper safety limit of 52%.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    No statistically significant changes were observed in levels of LDL-cholesterol, HDL-cholesterol, or triglycerides.

    “No statistically significant changes were observed in levels of LDL-, HDL-cholesterol and TG.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    In obese hypogonadal men with type 2 diabetes, HbA1c decreased significantly after one year in the testosterone replacement therapy group and in the placebo group, with a significant between-group difference.

    “| | T 1 -T 0 delta | À0.24 ± 0.39 | À0.94 ± 0.88 | p < .001 |”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In obese hypogonadal men with type 2 diabetes, fasting plasma glucose decreased significantly after one year in the testosterone replacement therapy group but not in the placebo group, with a significant between-group difference.

    “| | T 1 -T 0 delta | À0.13 ± 0.73 | À1.23 ± 1.25 | p < .001 |”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In obese hypogonadal men with type 2 diabetes, bioavailable testosterone increased significantly after one year in the testosterone replacement therapy group and in the placebo group, with a significant between-group difference.

    “| | T 1 -T 0 delta | 1.12 ± 0.93 | 5.76 ± 2.16 | p < .001 |”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In obese hypogonadal men with type 2 diabetes, flow-mediated dilatation increased significantly after one year in the testosterone replacement therapy group but not in the placebo group, with a significant between-group difference.

    “| | T 1 -T 0 delta | À0.08 ± 3.33 | 2.40 ± 4.16 | p 5 .019 |”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In obese hypogonadal men with type 2 diabetes, insulin decreased significantly after one year in the testosterone replacement therapy group but not in the placebo group, with a significant between-group difference.

    “| | T 1 -T 0 delta | À0.51 ± 4.48 | À8.52 ± 7.76 | p < .001 |”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In obese hypogonadal men with type 2 diabetes, intima-media thickness decreased significantly after one year in both the testosterone replacement therapy group and the placebo group, with a significant between-group difference.

    “| | T 1 -T 0 delta | À0.05 ± 0.09 | À0.10 ± 0.06 | p 5 .025 |”
    Quote in the paperSubstantial claim

  • May combine two claims. The quote only partly states this claim.

    Findingown data

    In obese hypogonadal men with type 2 diabetes, calculated free testosterone increased significantly after one year in the testosterone replacement therapy group and in the placebo group, with a significant between-group difference.

    “| | T 1 -T 0 delta 49.93 ± 40.67 | 248.29 ± 99.45 | p < .001 | |”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    In obese hypogonadal men with type 2 diabetes, HOMA-IR decreased significantly after one year in the testosterone replacement therapy group but not in the placebo group, with a significant between-group difference.

    “| | T 1 -T 0 delta | À0.52 ± 2.07 | À4.64 ± 4.25 | p < .001 |”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In obese hypogonadal men with type 2 diabetes, total testosterone increased significantly after one year in the testosterone replacement therapy group and in the placebo group, with a significant between-group difference.

    “| | T 1 -T 0 delta | 1.87 ± 1.54 | 9.80 ± 3.59 | p < .001 |”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductown data

    The study was a one-year, randomized, double-blind, placebo-controlled study of 55 obese DM2 male patients with confirmed untreated late-onset hypogonadism.

    “This was a one-year, randomized, double-blind, placebo-controlled study of 55 obese DM2 male patients not treated with insulin, with confirmed untreated late-onset hypogonadism (LOH) who were registered at the Diabetic outpatient clinic of the General hospital Celje.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Approximately 50% of older male patients with type 2 diabetes have decreased testosterone levels.

    “Approximately, 50% of older (age >40 years) male patients with type 2 diabetes mellitus (DM2) have decreased testosterone (T) levels”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [1] source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Low testosterone is associated with obesity, dyslipidemia, and hypertension, all of which increase the risk of cardiovascular disease.

    “Low T is also associated with obesity, dyslipidemia, and hypertension, all of which increase the risk of cardiovascular disease (CVD) [5].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [5] source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Observational studies have demonstrated that TRT reduces intima media thickening regardless of BMI, increases coronary artery diameter and rate of blood flow, and improves time to cardiac ischemia in men with coronary heart disease.

    “Observational studies have demonstrated that TRT reduces the intima media thickening regardless of body mass index (BMI), increases coronary artery diameter and the rate of blood flow, and improves time to cardiac ischemia in men with coronary heart disease [13].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [13] source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    DM2 and insulin resistance reduce testosterone biosynthesis.

    “DM2 and insulin resistance (IR) reduce T biosynthesis”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [3] source

      Not checked in the free run.

    • cites [4] source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Multiple studies have shown that TRT in obese hypogonadal diabetic male patients reduces plasma glucose, HbA1c, cholesterol, IR, inflammation, and NAFLD.

    “Multiple studies have shown that testosterone replacement therapy (TRT) in obese hypogonadal diabetic male patients reduces plasma glucose, HbA1c, cholesterol, IR, inflammation, NAFLD”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [2,[6][7][8][9]

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Other studies were unable to prove these effects or have shown opposite effects.

    “Other studies were unable to prove these effects or have shown opposite effects [10][11][12].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [10][11][12]

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Endothelial dysfunction is both an early functional marker of vascular disease and a facilitative process in the development of atherosclerosis.

    “Endothelial dysfunction is both an early functional marker of vascular disease and a facilitative process in the development of atherosclerosis [14].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [14] source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Decreased testosterone level increases insulin resistance and the occurrence of DM2.

    “decreased T level increases IR and the occurrence of DM2 [3,4].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [3] source

      Not checked in the free run.

    • cites [4] source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Results indicate that TRT improves IR, which ameliorates FPG and HbA1c levels.

    “Results of this study indicate that TRT improves IR, which ameliorates FPG and HbA1c levels.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Some epidemiological studies have reported an increase in cardiovascular mortality related to TRT while others have not been able to establish a correlation.

    “Some epidemiological studies have reported an increase in cardiovascular mortality related to TRT while others have not been able to establish a correlation between the two [19,20].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [19] source

      Not checked in the free run.

    • cites [20] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    Calculated free testosterone and bioavailable testosterone levels were calculated using the method of Vermeulen.

    “Calculated free testosterone (cFT) and bioavailable testosterone (BT) levels were calculated from SHBG, serum albumin, and TT levels using the method of Vermeulen [27].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [27] source

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    In the present study, factors other than testosterone replacement therapy also affected intima-media thickness, with lipid-lowering medication (HMG-CoA reductase inhibitors) being the most likely culprit, along with overall weight loss and improvement in glycemic control.

    “Results indicate that other factors were also affecting IMT in addition to TRT, lipidlowering medication (HMG-CoA reductase inhibitors) being the most likely culprit along with overall weight loss and improvement in glycemic control.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Androgen receptor expression is lower in elderly males with DM2.

    “It has been shown that AR expression is lower in elderly males with DM2 [16].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [16] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    The funder played no role in study design, data analysis, or in writing of this manuscript.

    “The funder played no role in study design, data analysis, or in writing of this manuscript.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    A prospective study has shown that TRT improves endothelial function.

    “A prospective study has shown that TRT improves endothelial function [18].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [18] source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data

    The baseline characteristics of the placebo and testosterone groups were not statistically different, except for IMT.

    “The baseline characteristics of placebo and testosterone group were not statistically different, the sole exception being IMT.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Study design and conductnone given

    No other potential conflicts of interest relevant to this study exist.

    “No other potential conflicts of interest relevant to this study exist.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductnone given

    Use of any oral hypoglycemic medication was permitted and patients continued on the same medication throughout the study without dose adjustments.

    “Use of any oral hypoglycemic medication was permitted and patients continued on the same medication throughout the study without dose adjustments.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    TRT has beneficial effect on sexual function and quality of life.

    “It is also well documented that TRT has beneficial effect on sexual function and quality of life [23][24][25].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [23][24][25]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    All measurements were carried out by the same investigator.

    “All measurements were carried out by the same investigator.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    Patients were not advised to introduce any dietary or other lifestyle changes during the study.

    “Patients were not advised to introduce any dietary or other lifestyle changes during the study.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    The study was approved by the National ethical committee and written informed consent was obtained from all subjects.

    “This study conformed to the principles outlined in the Declaration of Helsinki and was approved by the National ethical committee.Written informed consent was obtained from all subjects prior to their participation in the study.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Bayer Pharma AG provided testosterone and placebo without influencing the study protocol.

    “Bayer Pharma AG (Berlin, Germany) provided testosterone and placebo without influencing the study protocol.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Laboratory and clinical studies have found that testosterone at normal concentrations acts as a direct vasodilator, independent of activity on androgen receptors.

    “Laboratory and clinical studies have found that T at normal concentrations acts as a direct vasodilator, independent of activity on AR [17].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [17] source

      Not checked in the free run.

41 of 41

  • The paper relies on this without support.

    The observed improvements in glycemic control and vascular function in the TRT group are attributable to testosterone replacement therapy rather than to placebo effects, lifestyle changes, or other concurrent treatments.

    “We have shown that one year of TRT improved insulin sensitivity and glycemic control and reversed endothelial dysfunction in obese hypogonadal men with DM2.”

  • The paper relies on this without support.

    HOMA-IR is a valid surrogate measure of insulin sensitivity in obese hypogonadal men with DM2.

    “The homeostasis model assessment of insulin resistance index (HOMA-IR) was calculated as: HOMA-IR ¼ fasting glucose ðmmol=lÞ Â fasting insulin ðmU=lÞ=22:5”

  • The paper relies on this without support.

    The eugonadal range for total testosterone used to define normalization is appropriate for this population.

    “pushing all group T patients well into eugonadal range.”

  • The paper relies on this without support.

    The safety parameters measured (hematocrit, PSA, adverse events) are sufficient to conclude that TRT exerted no ill effects.

    “No adverse health effects related to TRT have been observed in study population throughout the one year of our study.”

  • The paper relies on this without support.

    The study population's baseline characteristics are representative of obese hypogonadal men with type 2 diabetes.

    “Fifty-five hypogonadal men, aged 40-70 years (mean 60.15 ± 7.23 years) with DM2 were included in this study.”

  • The paper relies on this without support.

    Adherence to lifestyle changes in obese men with type 2 diabetes is poor, making this approach rather unsuccessful.

    “On the other hand, the adherence to lifestyle changes in these patients is poor, making this approach rather unsuccessful.”
6 of 6

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • IMT was not the only baseline difference

    Minor

    The text says IMT was the sole baseline characteristic that differed between groups, but Table 2 also reports a significant baseline difference in bioavailable testosterone.

1 of 1

Cites

Flagged first, then by citations

Research works printed but not linked: 7

  1. Zitzmann M, 2009, J Mens Health, 6, 243
  2. Panach-Navarrete J, 2017, Aging Male, 20, 146
  3. Mårin P, 1996, J Clin Endocrinol Metab, 81, 1018
  4. Maggio M, 2014, Endocr Pract Off J Am Coll Endocrinol Am Assoc Clin Endocrinol, 20, 1170
  5. Mazo E, 2008, Ter. Arkh, 80, 59
  6. 10.1210/jcem.87.8.8762 · DOI
  7. Poredos P, 1997, Vasa, 26, 271

Cited by

Sorted by citations

Related

Authors
Groti, K., Žuran, I., Antonič, B., Foršnarič, L., & Pfeifer, M.
Affiliations
  • Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Center, Ljubljana, Slovenia;
  • Department of Angiology, Endocrinology and Rheumatology, General Hospital Celje, Celje, Slovenia;
  • Blaž Antonič s.p., IT Equipment Development, Ljubljana, Slovenia;
  • University of Ljubljana (SI)
Venue
The Aging Male
Publisher
Informa UK Limited
Published
2018-04-30
Volume
21
Issue
3
Pages
158-169
ISSN
  • 1368-5538 (ISSN-L)
  • 1473-0790
DOI
10.1080/13685538.2018.1468429
OpenAlex
W2800747531
Semantic Scholar
2911430b69cf229bc6e8d49b305b50ddde36dbef
Cited by
117
References
78
Citations by year
2026: 7 · 2025: 5 · 2024: 13 · 2023: 11 · 2022: 27 · 2021: 15 · 2020: 20 · 2019: 13 · 2018: 6
FWCI
10.74
Type
journal article
Language
en
Open access
Locations
  • The Aging Male (publishedVersion)
  • PubMed (publishedVersion)
Funders
Bayer
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal and reproductive studies
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Menopause: Health Impacts and Treatments
Keywords
testosterone replacement therapy, testosterone undecanoate, hypogonadism, type 2 diabetes, obesity, metabolic syndrome, glycemic control, insulin resistance, endothelial function, flow-mediated dilation, intima-media thickness, HbA1c, free testosterone, bioavailable testosterone
MeSH terms
Adult, Aged, Androgens, Blood Glucose, Cardiovascular System, Diabetes Mellitus, Type 2, Double-Blind Method, Glycated Hemoglobin, Humans, Hypogonadism, Male, Middle Aged, Obesity, Testosterone, Hormone Replacement Therapy, Metabolic Syndrome, Glycemic Index

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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-10.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-10.

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